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Obstetrics I - OSCE > DM > Flashcards

DM Flashcards

1
Q
A
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2
Q

Modified White Classification of DM in Pregnancy

A
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3
Q

Modified White Classification of DM in Pregnancy

  • A1 & A2
A
  • A1: → FBS < 105 mg/d| & PPS < 120 mg/di.
    A2: → FBS > 105 mg/dl & PPS > 120 mg/dl.
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4
Q

RF for GDM

A
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5
Q

Effects of Pregnancy on DM

A
  • Pregnancy is Diabetogenic
  • Change in Insulin Requirments
  • Increased Incidence of DM Complications
  • Aggravation of Retinopathy & Nephropathy
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6
Q

Effects of DM on Pregnancy

A

Maternal & Fetal & Neonatal

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7
Q

Maternal Effects of DM on Pregnancy

A
  • During Pregnancy
  • During labor
  • During Puerperium
  • Late Complications
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8
Q

Maternal Effects of DM on Pregnancy

  • Abortion
A

Due to Ag-Ab reaction associating DM or chromosomal abnormalities.

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9
Q

Maternal Effects of DM on Pregnancy

  • Preterm Labor
A

3-4 times higher in diabetics (MgSO4 is the tocolytic of choice).

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10
Q

Maternal Effects of DM on Pregnancy

  • Polyhydraminos
A
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11
Q

Maternal Effects of DM on Pregnancy

  • HTN
A

Due to vasculopathy or nephropathy.

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12
Q

Maternal Effects of DM on Pregnancy

  • Infection
A

UTI, vulvovaginitis (monilia) or chorioamnionitis (after ROM).

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13
Q

Maternal Effects of DM on Pregnancy

  • During Pregnancy
A
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14
Q

Maternal Effects of DM on Pregnancy

  • During Labor
A
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15
Q

Maternal Effects of DM on Pregnancy

  • During puerperium
A
  1. PPH & puerperal sepsis.
  2. Abnormal lactation: Due to changes in glucose level.
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16
Q

Maternal Effects of DM on Pregnancy

  • Late Complications
A

50% of cases è GDM will develop overt DM later on.

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17
Q

Neonatal Effects of DM on Pregnancy

A
  • Respiratory distress syndrome (RDS)
  • Hypertrophic cardiomyopathy
  • Hypoglycemia
  • Hypocalcemia & hypomagnesemia
  • Hyperbilirubinemia
  • Polycythemia
  • Poor Feeding
  • Birth Trauma
  • Late Complications
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18
Q

Neonatal Effects of DM on Pregnancy

  • RDS
A
  • Due to delayed lung maturity (because hyperinsulinemia inhibits secretion of pulmonary surfactant).
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19
Q

Neonatal Effects of DM on Pregnancy

  • Hypoglycemia
A

Blood glucose level < 40 mg/d| (due to hyperinsulinemia)

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20
Q

Neonatal Effects of DM on Pregnancy

  • Hyperbilirubenemia
A

Due to delay in liver maturation.

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21
Q

Neonatal Effects of DM on Pregnancy

  • Polycythemia
A

Hct value > 65% (due to chronic intrauterine hypoxia → T T erythropoietin production).

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22
Q

Neonatal Effects of DM on Pregnancy

  • Poor Feeding
A

Due to prematurity, RDS or congenital anomalies

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23
Q

Neonatal Effects of DM on Pregnancy

  • Late Complications
A

Increased risk of development of type I DM later in life (1-3% if mother only is diseased & 6% if father is diseased also

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24
Q

Fetal Effects of DM on Pregnancy

A
  • Congenital Anomalies
  • Macrosomia
  • IUGR
  • IUFD
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25
Q

Fetal Effects of DM on Pregnancy

  • Congenital Anomalies
A
26
Q

Most Common Congenital Anomalies in pregnancy with DM

A

Specially VSD

27
Q

Most Specific Congenital Anomalies in Pregnancy in DM

A

Sacral agenesis (caudal regression or caudal dysplasia)

28
Q

Fetal Effects of DM on Pregnancy

  • Macrosomia
A
29
Q

Dx of DM in Preegnancy

  • Hx
A
30
Q

Dx of DM in Preegnancy

  • Ex
A

Signs of complications (maternal or fetal).

31
Q

Dx of DM in Preegnancy

  • Investigations
A
  • Test for glucosuria
  • Oral glucose tolerance tests (OGTTs)
  • Glycosylated HbA1 (HbA1c)
  • Investigations to detect complications
32
Q

Investigations for DM in pregnancy

A

…

33
Q

Investigations for DM in pregnancy

  • Glucosuria
A

Done in each ANC visit & if +ve → blood investigations.

34
Q

Investigations for DM in pregnancy

  • OGTT
A
  • 50gm 1-hour OGTT
  • 100 gm 3-hours OGTT
35
Q

Best Screening Test in DM with Pregnancy

A

50gm 1-hour OGTT

36
Q

50gm 1-hour OGTT

A
37
Q

The gold standard for diagnosis of GDM

A

100 gm 3-hours OGTT

38
Q

100 gm 3-hours OGTT

A
39
Q

Investigations for DM in pregnancy

  • HbA1c
A
40
Q

Managment of DM in Pregnancy

  • Pre-Conceptional Care
A
41
Q

Pre-Conceptional Care for DM in Pregnancy

A
42
Q

ANC for DM in Pregnancy

A
43
Q

ANC for DM in Pregnancy

  • Frequency of Visits
A
44
Q

Glycemic Control for DM in Pregnancy

A
  • Dietary recommendation
  • Insulin therapy
45
Q

Glycemic Control for DM in Pregnancy

  • Dietary Recommendations
A
46
Q

Glycemic Control for DM in Pregnancy

  • Insulin Therapy
A

The standard treatment for DM è pregnancy.

47
Q

Insulin Therapy for DM in Pregnancy

A
48
Q

Insulin Therapy for DM in Pregnancy

  • Goals
A

Keeping FBS < 105 mg/dl & 2 hours PPS < 120 mg/di.

49
Q

Insulin Therapy for DM in Pregnancy

  • Insulin Preparations
A

Ultrashort, short, intermediate & long acting.

50
Q

Insulin Therapy for DM in Pregnancy

  • Routes of adminstration
A

SC

51
Q

Insulin Therapy for DM in Pregnancy

  • Calculation of dose
A

In 1st half of pregnancy: → Body weight x 0.6 units/day.

In 2nd half of pregnancy: → Body weight x 0.7 units/day.

52
Q

Insulin Therapy for DM in Pregnancy

  • regimens
A
53
Q

Time of Delivery for A1 GDM

A

At 40 weeks (EDD)

54
Q

Time of Delivery for GDM Other than A1

A

At 38 weeks

55
Q

When to deliver at >37 weeks in GDM?

A
56
Q

Prerequisites before induction of lobor in DM in Pregnancy

A
57
Q

Precautions in Vaginal delivery DM in Pregnancy

A
58
Q

CS in DM in Pregnancy

A

DM not indication for CS → ass. è increased incidence of CS (CS rate reaches 47%).

59
Q

Indications of CS in DM in Pregnancy

A
60
Q

Precautions of CS in DM in Pregnancy

A
  • Glycemic control.
  • Prophylactic antibiotics.
  • Anesthesia: General anesthesia is the standard.
61
Q

Neonatal Care in DM in Pregnancy

A
62
Q

Perinatal Mortality in DM in Pregnancy

A

2-5% (50% of them are due to congenital anomalies).

Obstetrics I - OSCE (32 decks)

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