Exam 2: HIV, GDM, HTN Flashcards
HIV: acute phase
viral production
flu like symptoms for 2-4 weeks after exposure
ability to spread HIV the highest –> CD4 count drops
HIV: latency phase
viral rep continues with lymphatics, but slows down
free of symptoms
HIV: persistent generalized lymphadenopathy
possibly remaining in this stage for years; AIDS develops within 7 to 10 years
AIDS
high viral load and low CD4 count
Perinatal transmission of HIV is called
vertical tranmission
How do we treat HIV in pregnancy women
Antiretroviral therapy 2x daily from 14 weeks until birth; IV admin during labor
AVOID INSTRUMENTATION SUCH AS EPISIOTOMIES, FETAL SCALP ELECTRODES
How do we treat HIV in newbords
liquid antiretroviral (retrovir) for 1-6 weeks of life
T/F a pregnant woman who is HIV positive must undergo a C/S
F, only when viral load is high enough
If you get GDM are you at a higher risk for developing DM type 2
yes
Type 1 DM
autoimmune, insulin deficient
Type 2 DM
insulin resistant
Glucose intolerance
fasting glu of 100-125
risk of LGA infants
GDM
any degree of glu intolerance first detected in pregnancy
Maternal complications of GDM
Dystocia or difficult labor
C section
Still born
Increased risk of developing preeclampsia
more frequent UTI
Hydramnios
Chronic vaginitis
Fetal complications from GDM
LGA/Macrosomia
hypoglycemia
fetal asphyxia
respiratory distress
jaundice
stillborn
First trimester: _______ in need for insulin
decrease
risk of hypoglycemia secondary to morning sickness
First trimester: decreased ______ = decreased need for insulin
hPL
2nd and 3rd trimester: insulin requirement _________
increases
2nd and 3rd trimester: increase in…
glucose use and storage
Insulin need during labor
increased energy needs during labor may require increased insulin to balance IV glucose
Insulin in post partum
abrupt decrease in insulin required
Pregnancy and insulin chart
peripheral insulin R –> compensatory increase in insulin secretion –> increase glu demandes in increase hPL –> insulin resistance peaks at 3rd tri –> postprandial hyperglycemia (repeat)
Screening for GDM in pregnancy
all women under a risk assessment at 1st prenatal visit
high risk women reassessed between 24-28 weeks
First visit glucose blood levels
Fasting (over 125)
HbA1C (over 7%)
random (over 200)
24-28 weeks glucose blood levels
Fasting (over 95)
75g OGTT 1hr (over 180)
75g OGTT 2 hr (over 153)
GDM can only be diagnosed using what
oral glucose tolerance test (at 24-28 weeks)
hypoglycemia in a newborn
glucose less than 40
S/S of hypoglycemia in a newborn
apnea
cyanosis and seizures
poor feedings
jitteriness
lethargy
weak cry
hypothermia
Care management: maternal monitoring for GDM
Physical exam
urine test
eye exam in 1st tri
renal function each tri
HbA1C every 4-6 weeks
Fetal monitoring for GDM
non-stress test
genetic screening like alpha fetoprotein
amniocentesis
Care of women with diabetes during labor
IV saline or lactated ringer’s
Monitor blood glucose every 1 to 2 hours
infusion of regular insulin
insulin requirement drops quickly after birth so monitor for hypoglycemia
Post partum breastfeeding aids in blood glucose homeostasis
transfer of mother’s glucose to breast milk to feed the baby
colostrum helps balance baby’s blood sugar levels
Glucose challenge test at ______ weeks post partum
6 wks –> if normal it’s screened every 3 years
Chronic HTN
present before the pregnancy or diagnosed before 20 weeks gestation
BP equal to 140/90 or greater
Gestation HTN
after 20 weeks gestation but no proteinuria
Preeclampsia
140/90 or greater after 20 weeks gestation AND protein in urine, epi abdominal pain, neuro complications, liver involvement, elevated Cr
eclampsia
all the same as pre- but added seizures
Chronic HTN is associated with increased incidence of
abruptio placentae = hemorrhage
superimposed preeclampsia
increased perinatal mortality
SGA in infant
What is the diagnostic criteria for GHTN
onset during pregnancy based on two measurements that meet criteria for BP elevation within 1 week period
Do S/S disappear after birth for preeclampsia
yes
Pathophysiology of preeclampsia
disruption in placental perfusion and endothelial cell dysfunction
poor perfusion from vasospasm
What is disseminated intravascular coagulation
blood clot formation in small vessels
HEELP
Hemolysis
Elevated liver enzymes
Low platelet
Hepatic dysfunction
What stimulates lung maturity in fetus
dexamethasone or betamethasone
What is a normal patellar reflex
2+
How do we diagnose/test proteinuria
dipstick
24 hour collection (gold standard)
Drug treatment of HTN in pregnancy
“her new lab method”
hydralazine
nifedipine
labetalol
methyldopa
Why do we use Mg sulfate
prophylactically to prevent seizures
Loading dose of Mg sulfate
Maintenance dose
4-6 mg over 15 to 30 minutes
dilute in 1000 mL LR, give 2g/hour
Therapeutic range of Mg
4-7
Antidote of Mg toxicity
calcium gluconate
