Gestational Diabetes, Mole, Rh, HEG - PANCE Pearls Flashcards
What are the risk factors for gestational diabetes?
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
Pathophysiology of gestational diabetes
placental release of growth hormone, corticotropin releaseing hormone and human placental lactogen (HPL) → antagonizes insulin → increases glucose availability for fetus
When should you perform 50 g oral glucose challenge test to screen for gestational diabetes?
24-28 weeks gestation
If your oral glucose challenge test is <140 mg/dL after 1 hour, what do you do next?
3 hours GTT
Gold standard for diagnosing gestational diabetes
Glucose Tolerance Test (GTT)
Treatment of choice for gestational diabetes
insulin (won’t cross placenta)
What are the indications for insulin in gestational diabetes
fasting blood glucose < 105 and postprandial > 120
Two medications (besides insulin) that can be used in gestational diabetes
glyburide and metformin
If your patient has uncontrolled gestational diabetes and macrosomia, when can you induce labor?
38 weeks
Fetal complications of gestational diabetes
fetal demise, congenital malformation, premature labor, neonate hypoglycemia, hyperglycemia, shoulder dystocia, macrosomia, birth trauma, neonatal hypocalcemia, hyperbilirubinemia
Maternal complications of gestational diabetes
preeclampsia, abruptio placentae, > 50% chance of developing DM after pregnancy, > 50% chance of recurrence with subsequent pregnancies
When should you screen a patient postpartum for for DM?
6 weeks and yearly
When is the onset and duration of postpartum blues?
2-4 days postpartum
resolves within 10 days
what is the onset of postpartum depression?
2 weeks - 2 months postpartum
resolves within 3-14 months
How does postpartum blues differ from postpartum depression?
Postpartum depression may have thoughts of harming the baby
Management of postpartum depression
antidepressant
Management of postpartum blues
none → self limited
Wide array of disorders associated with abnormal placental trophoblastic tissue
gestational trophoblastic disease
4 types of gestational trophoblastic disease
molar pregnancy (benign)
invasive mole
choriocarcinoma
placental site trophoblastic tumor
neoplasm due to abnormal placenta development with trophoblastic tissue proliferation arising from gestational tissue (not of maternal origin)
hydatidiform mole
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
complete molar pregnancy
egg is fertilized by 2 sperm → if fetus develops it is malformed and nonviable
partial molar pregnancy
MC risk factors for partial molar pregnancy
prior molar pregnancy
maternal age < 20 or > 35 years
Asian
pathophysiology of molar pregnancy
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
Clinical manifestations of molar pregnancy
painless vaginal bleeding, uterine size/date discrepancies, hyperemesis gradivarum
How can you diagnose molar pregnancy ?
B-hCG markedly elevated (>100,000) or US
How will molar pregnancy present on US?
“snowstorm” or “cluster of grapes” → won’t see fetal parts and heart sounds in complete
Management of molar pregnancy
surgical uterine evacutation → suction curettage ASAP (avoid risk of choriocarcinoma development)
How do you treat choriocarcinoma mets?
chemotherapy → Methotrexate
Result of fertilization of 2 ova by 2 different sperm
fraternal (dizygotic)
fored from the fertilization of 1 ovum → increased risk of fetal transfusion syndrome and discordant fetal growth
identical (monozygotic)
Maternal complications of multiple gestations
preterm labor, spontaneous abortion, preeclampsia, anemia
Fetal complications of multiple gestations
intrauterine growth restriction, placental abnormalities, breech position, umbilical cord prolapse, preeclampsia
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
Rh Alloimmunization
Clinical manifestations of Rh positive newborn
hemolytic anemia, jaundice, kernicterus, hepatosplenomegaly, fetal hydrops
Tests for diagnosing Rh factor in pregnant woman
ABO blood group, Rh-D type, indirect erythrocyte antibody screen, indirect Coombs
What do you monitor in the 2nd trimesters in fetus at risk for Rh alloimmunization
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)
When do you administer RhoGAM in Rh negative mother?
at 28 weeks gestation AND within 72 hours of delivery
How long does morning sickness usually last?
up until 16 weeks
severe, excessive form of morning sickness associated with weight loss, electrolyte imbalance → develops in 1st/2nd trimester and persists > 16 weeks gestation
hyperemesis gravidarum (HEG)
Pathophysiology of HEG
vomiting center is oversensitive to pregnancy hormones
What antiemetics are first line for HEG?
pyridoxine (B6) +/- doxylamine
