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Women's Health > Gestational Diabetes > Flashcards

Gestational Diabetes Flashcards

1
Q

describe pregestational diabetes

A

type 1- no insulin production
type 2- decreased insulin production
*both will have greatly increased diabetic complications

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2
Q

what is IUFD

A

intrauterine fetal demise is loss of fetus in utero

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3
Q

what is HCS also known as

A

HPL

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4
Q

what is IUGR

A

intrauterine growth restriction

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5
Q

what is gestational diabetes

A

carbohydrate intolerance (variable severity)
may require insulin for regulation
4-14% of all pregnant women

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6
Q

does gestational diabetes persist after pregnancy

A

it may

50% of gestational will convert to type 2 following pregnancy

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7
Q

when is gestational considered resolved

A

about 15-24 hrs after placenta delivers

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8
Q

risk factors of gestational diabetes

A

hx of gestational dm, family hx of dm, previous infant > 9 lbs, previous IUFD, obesity, >25 yrs

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9
Q

patho of gestational diabetes

A

human chorionic sommatomamotropin (HCS) causes insulin resistance

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10
Q

insulin needs in 2nd and 3rd trimester

A

increase in HCS causes need for MORE insulin

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11
Q

describe glucose in relation to fetus

A

primary fuel for fetus, glucose crosses placenta, insulin does NOT cross

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12
Q

what causes gestational diabetes

A

sensitivity to HCS or HPL

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13
Q

potential maternal morbidity with diabetes

A

preeclampsia, infection, postpartum bleeding, cesarean section

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14
Q

describe the maternal morbidity causes

A

preeclampsia; due to vascular inflammation
infection; due to increases glucose
postpartum bleeding; due to large fetus
cesarean section; due to large infant

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15
Q

potential fetal morbidity with diabetes

A

macrosomia, IUGR, neonatal hypoglycemia, decrease in surfactant

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16
Q

describe the fetal morbidity causes

A

macrosomia/birth trauma; d/t maternal hyperglycemia
IUGR; poor placental perfusion
neonatal hypoglecemia; monitor BS 3 hrs after birth

17
Q

higher circulating glucose=

A

LOWER SURFACTANT production

18
Q

decrease in surfactant…

A

5x greater risk of respiratory distress

19
Q

what is amniocentesis

A

test amniotic fluid to determine if fetus has enough surfactant to be born (usually done when woman comes in preterm and she is contracting)

20
Q

signs and symptoms of gestational diabetes

A

hydramnios, macrosomnia/ increased fundal ht, persistent glycosuria, ketonuria

21
Q

what is hydramnios

A

too much amniotic fluid

22
Q

what do you want the non fasting glucose level below

A

130

23
Q

if nonfasting glucose is ___ then immediately diabetic and no need for OGTT

A

200

24
Q

if > 200 lbs at prenatal entry…

A

assess glucose (GST) at first visit AND then also at 24 weeks

25
Q

if low risk or normal weight at prenatal entry…

A

GST between 24 and 28 weeks of pregnancy

26
Q

how does GST work

A

glucose screening test
administer 50 g of glucose
no fast, if >130 mg/dL then need a 3 hr OGTT

27
Q

how is OGTT done

A

fast
check initial, 1 hr, 2 hr, and 3 hr
if two of four glucose levels are elevated then diabetic

28
Q

treatment for gestational diabetes

A

diet (50% from carbs), exercise, daily BG log (1-4x a day)

29
Q

diet if obese and normal wt

A

obese: 1500 cal restriction
normal: 2400 cal restriction

30
Q

drugs for gestational diabetes

A

oral hypoglycemic drugs

insulin

31
Q

oral hypoglycemic drugs for gestational

A

Glyburide: sulfonylurea(increases insulin production from beta cells)
Metformin: biguanidine (decreases gluconeogenesis in liver and decreases glucose)

32
Q

insulin regimen for gestational

A

2:1 ratio, NPH and regular taken before dinner and breakfast

33
Q

how do insulin needs change towards end of pregnancy

A

during pregnancy: insulin needs continue to increase
during labor: may/may not need insulin
during postpartum: decrease at 24 hr after loss of placenta due to DECREASE in HPL

34
Q

important nursing care for gestational diabetes

A

EDUCATION
poor glycemic control effects
dietary teaching and exercise review

35
Q

prenatal care for gestational dm

A

prenatal care every 2 wks until 3rd trimester (then every week)
routine non stress test to ensure placenta not damaged

36
Q

what should be regularly checked for diabetes

A

check Lecithin-sphingomyelin ratio

L/S ratio for lung maturity

37
Q

what happens if L/S ratio is low

A

will NOT deliver because surfactant is too low

38
Q

what needs to be monitored at birth if gestational diabetes

A

monitor for hypoglycemia at birth

39
Q

DKA in gestational

A

diabetic ketoacidosis
neurological squeale due to ketosis
perinatal mortality= 90% if DKA
maternal mortality=5-15% if DKA

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