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Obstetrics > Gestational Diabetes, Mole, Rh, HEG - PANCE Pearls > Flashcards

Gestational Diabetes, Mole, Rh, HEG - PANCE Pearls Flashcards

1
Q

What are the risk factors for gestational diabetes?

A

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

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2
Q

Pathophysiology of gestational diabetes

A

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

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3
Q

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

A

24-28 weeks gestation

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4
Q

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

A

3 hours GTT

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5
Q

Gold standard for diagnosing gestational diabetes

A

Glucose Tolerance Test (GTT)

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6
Q

Treatment of choice for gestational diabetes

A

insulin (won’t cross placenta)

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7
Q

What are the indications for insulin in gestational diabetes

A

fasting blood glucose < 105 and postprandial > 120

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8
Q

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

A

glyburide and metformin

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9
Q

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

A

38 weeks

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10
Q

Fetal complications of gestational diabetes

A

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

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11
Q

Maternal complications of gestational diabetes

A

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

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12
Q

When should you screen a patient postpartum for for DM?

A

6 weeks and yearly

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13
Q

When is the onset and duration of postpartum blues?

A

2-4 days postpartum

resolves within 10 days

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14
Q

what is the onset of postpartum depression?

A

2 weeks - 2 months postpartum

resolves within 3-14 months

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15
Q

How does postpartum blues differ from postpartum depression?

A

Postpartum depression may have thoughts of harming the baby

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16
Q

Management of postpartum depression

A

antidepressant

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17
Q

Management of postpartum blues

A

none → self limited

18
Q

Wide array of disorders associated with abnormal placental trophoblastic tissue

A

gestational trophoblastic disease

19
Q

4 types of gestational trophoblastic disease

A

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

20
Q

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

A

hydatidiform mole

21
Q

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

A

complete molar pregnancy

22
Q

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

A

partial molar pregnancy

23
Q

MC risk factors for partial molar pregnancy

A

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

24
Q

pathophysiology of molar pregnancy

A

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

25
Q

Clinical manifestations of molar pregnancy

A

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

26
Q

How can you diagnose molar pregnancy ?

A

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

27
Q

How will molar pregnancy present on US?

A

“snowstorm” or “cluster of grapes” → won’t see fetal parts and heart sounds in complete

28
Q

Management of molar pregnancy

A

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

29
Q

How do you treat choriocarcinoma mets?

A

chemotherapy → Methotrexate

30
Q

Result of fertilization of 2 ova by 2 different sperm

A

fraternal (dizygotic)

31
Q

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

A

identical (monozygotic)

32
Q

Maternal complications of multiple gestations

A

preterm labor, spontaneous abortion, preeclampsia, anemia

33
Q

Fetal complications of multiple gestations

A

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

34
Q

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

A

Rh Alloimmunization

35
Q

Clinical manifestations of Rh positive newborn

A

hemolytic anemia, jaundice, kernicterus, hepatosplenomegaly, fetal hydrops

36
Q

Tests for diagnosing Rh factor in pregnant woman

A

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

37
Q

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

A

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)

38
Q

When do you administer RhoGAM in Rh negative mother?

A

at 28 weeks gestation AND within 72 hours of delivery

39
Q

How long does morning sickness usually last?

A

up until 16 weeks

40
Q

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

A

hyperemesis gravidarum (HEG)

41
Q

Pathophysiology of HEG

A

vomiting center is oversensitive to pregnancy hormones

42
Q

What antiemetics are first line for HEG?

A

pyridoxine (B6) +/- doxylamine

Obstetrics (17 decks)

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