Gestational Diabetes, Mole, Rh, HEG - PANCE Pearls

Question 1

What are the risk factors for gestational diabetes?

Answer 1

family or prior history of gestational diabetes, spontaneous abortion, history of infant >4,000 g at birth, multiple gestations, obesity, > 25 years, AA/Hispanic/Asian/Pacific Islander/Native American

Question 2

Pathophysiology of gestational diabetes

Answer 2

placental release of growth hormone, corticotropin releaseing hormone and human placental lactogen (HPL) → antagonizes insulin → increases glucose availability for fetus

Question 3

When should you perform 50 g oral glucose challenge test to screen for gestational diabetes?

Answer 3

24-28 weeks gestation

Question 4

If your oral glucose challenge test is <140 mg/dL after 1 hour, what do you do next?

Answer 4

3 hours GTT

Question 5

Gold standard for diagnosing gestational diabetes

Answer 5

Glucose Tolerance Test (GTT)

Question 6

Treatment of choice for gestational diabetes

Answer 6

insulin (won’t cross placenta)

Question 7

What are the indications for insulin in gestational diabetes

Answer 7

fasting blood glucose < 105 and postprandial > 120

Question 8

Two medications (besides insulin) that can be used in gestational diabetes

Answer 8

glyburide and metformin

Question 9

If your patient has uncontrolled gestational diabetes and macrosomia, when can you induce labor?

Answer 9

38 weeks

Question 10

Fetal complications of gestational diabetes

Answer 10

fetal demise, congenital malformation, premature labor, neonate hypoglycemia, hyperglycemia, shoulder dystocia, macrosomia, birth trauma, neonatal hypocalcemia, hyperbilirubinemia

Question 11

Maternal complications of gestational diabetes

Answer 11

preeclampsia, abruptio placentae, > 50% chance of developing DM after pregnancy, > 50% chance of recurrence with subsequent pregnancies

Question 12

When should you screen a patient postpartum for for DM?

Answer 12

6 weeks and yearly

Question 13

When is the onset and duration of postpartum blues?

Answer 13

2-4 days postpartum

resolves within 10 days

Question 14

what is the onset of postpartum depression?

Answer 14

2 weeks - 2 months postpartum

resolves within 3-14 months

Question 15

How does postpartum blues differ from postpartum depression?

Answer 15

Postpartum depression may have thoughts of harming the baby

Question 16

Management of postpartum depression

Answer 16

antidepressant

Question 17

Management of postpartum blues

Answer 17

none → self limited

Question 18

Wide array of disorders associated with abnormal placental trophoblastic tissue

Answer 18

gestational trophoblastic disease

Question 19

4 types of gestational trophoblastic disease

Answer 19

molar pregnancy (benign)
invasive mole
choriocarcinoma
placental site trophoblastic tumor

Question 20

neoplasm due to abnormal placenta development with trophoblastic tissue proliferation arising from gestational tissue (not of maternal origin)

Answer 20

hydatidiform mole

Question 21

egg with no DNA is fertilized by 1 or 2 sperm → 46 XX [all paternal chromosomes] → associated with higher risk of malignant development into choriocarcinoma

Answer 21

complete molar pregnancy

Question 22

egg is fertilized by 2 sperm → if fetus develops it is malformed and nonviable

Answer 22

partial molar pregnancy

Question 23

MC risk factors for partial molar pregnancy

Answer 23

prior molar pregnancy
maternal age < 20 or > 35 years
Asian

Question 24

pathophysiology of molar pregnancy

Answer 24

abnormal pregnancy in which nonviable fertilized egg implants in the uterus with a nonviable pregnancy which will fail to come to term → abnormal placental development

Question 25

Clinical manifestations of molar pregnancy

Answer 25

painless vaginal bleeding, uterine size/date discrepancies, hyperemesis gradivarum

Question 26

How can you diagnose molar pregnancy ?

Answer 26

B-hCG markedly elevated (>100,000) or US

Question 27

How will molar pregnancy present on US?

Answer 27

"snowstorm" or "cluster of grapes" → won't see fetal parts and heart sounds in complete

Question 28

Management of molar pregnancy

Answer 28

surgical uterine evacutation → suction curettage ASAP (avoid risk of choriocarcinoma development)

Question 29

How do you treat choriocarcinoma mets?

Answer 29

chemotherapy → Methotrexate

Question 30

Result of fertilization of 2 ova by 2 different sperm

Answer 30

fraternal (dizygotic)

Question 31

fored from the fertilization of 1 ovum → increased risk of fetal transfusion syndrome and discordant fetal growth

Answer 31

identical (monozygotic)

Question 32

Maternal complications of multiple gestations

Answer 32

preterm labor, spontaneous abortion, preeclampsia, anemia

Question 33

Fetal complications of multiple gestations

Answer 33

intrauterine growth restriction, placental abnormalities, breech position, umbilical cord prolapse, preeclampsia

Question 34

neonate hemolytic disese where the mother is Rh (-) and the father is Rh (+) and mother prodcues antibodies against the fetal RBCs when the blood mixes

Answer 34

Rh Alloimmunization

Question 35

Clinical manifestations of Rh positive newborn

Answer 35

hemolytic anemia, jaundice, kernicterus, hepatosplenomegaly, fetal hydrops

Question 36

Tests for diagnosing Rh factor in pregnant woman

Answer 36

ABO blood group, Rh-D type, indirect erythrocyte antibody screen, indirect Coombs

Question 37

What do you monitor in the 2nd trimesters in fetus at risk for Rh alloimmunization

Answer 37

amniotic fluid (increase in bilirubin), US middle cerebral artery (increased flow secondary to decreased blood viscosity due to anemia), percutaneous umbilical blood smapling (decreased hematocrit)

Question 38

When do you administer RhoGAM in Rh negative mother?

Answer 38

at 28 weeks gestation AND within 72 hours of delivery

Question 39

How long does morning sickness usually last?

Answer 39

up until 16 weeks

Question 40

severe, excessive form of morning sickness associated with weight loss, electrolyte imbalance → develops in 1st/2nd trimester and persists > 16 weeks gestation

Answer 40

hyperemesis gravidarum (HEG)

Question 41

Pathophysiology of HEG

Answer 41

vomiting center is oversensitive to pregnancy hormones

Question 42

What antiemetics are first line for HEG?

Answer 42

pyridoxine (B6) +/- doxylamine