GDM Flashcards
Best parameter to detect macrosomia
Abdominal circumference more than 95th percentile for gestational age
Define GDM
Carbohydrate intolerance of variable severity with onset or first recognition during present pregnancy
High risk factors for GDM
Family h/o diabetes
Obesity
Older age group
Previous big baby
Polyhydramnios
Ethnicity - indian , south east asian
PCOD
What causes the diabetogenic state of pregnancy
Insulin resistance - human placental lactogen or placental samotommotropin , increased cortisol and steroids
Increased Lipolysis
Changed gluconeogenesis
What is DIPSI?
Diabetes in pregnancy study group of pregnancy
One step diagnostic test - done around 24-28 weeks.
Irrespective of last meal 75g of sugar with 200ml of water with citric flavouring for better palatability
Blood sugar checked after 2h if >140g/dl treat as GDM
What are the maternal complications in GDM?
Abortion - uncontrolled diabetes
Ketoacidosis due to hyperemesis garvidaram
Polyhydramnios - amniotic fluid> 2000 ml due to fetal polyuria and hyperosmosis
Increased risk of pre eclampsia and infection and instrumental delivery
What are the foetal complications of GDM?
Macrosomia, shoulder dystocia, unexplained foetal death, increased congenial abnormalities - caudal regression syndrome, CHD- AsD and VSD , transposition of great vessels, NTD
What are the neonatal complications in GDM?
RDS, hypoglycemia, hypocalcemia, hypothermia, hyperbilirubinemia, polycythemia, hyperviscosity due to increased RBCs - renal vein thrombosis and NEC, hypertrophic cardiomyopathy
Pedersen’s hypothesis
It describes the cause of macrosomia in GDM
Maternal hyperglycemia
1. Increased ffa transfer along the placenta, increased TG syn - Adiposity
- Hypertrophy and hyperplasia of foetal islets of langerhans - results in increased foetal insulin and igf - carbohydrate utilisation and increased fat accumulation - macrosomia
What is the Gabe rule of 15?
15% of positive GCT will have GDM
15% GDM will require insulin
15% GDM will have macrosomia
15% GDM will have type 2 DM after delivery
Antenatal monitoring in GDM
Weight gain should be monitored - to rule out pre eclampsia, polyhydramnios and macrosomia
Usg- dating and NT scan , anomaly scan to rule out major malformations , echo at 24 weeks for cardiac evaluation, monitor ac:hc , fetal kicks,
Define polyhydramnios
Excess of amniotic fluid>2000ml or AFI > 25cm or single pocket> 8cm
Causes of polyhydramnios
Maternal - diabetes mellitus
Foetal- multi pregnancy, NTD, anencephaly, tracheosophageal atresia, chorioangioma
Types of polyhydramnios
Acute - more commonly in monochorionic twins by 20weeks and results in preterm labour
Chronic - occurs after 32w
Clinical features of polyhydramnios
Abdominal size bigger than period of amenorrhea
Skin shiny and taut, uterus tense and non tender
Foetal parts difficult to palpate
Management of polyhydramnios
Rule out - maternal diabetes and anomalies
Mild no treatment
Indomethacin
Slow amniocentesis is done
Management of polyhydramnios
Rule out - maternal diabetes and anomalies
Mild no treatment
Indomethacin
Slow amniocentesis is done
