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Obstetrics > Gestational DM > Flashcards

Gestational DM Flashcards

1
Q

What population is at highest risk of GDM?

A

native americans

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2
Q

How do you control A1 Gestational Diabetes - abnormal GTT, normal FBG and PP?

A

diet control

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3
Q

How do you control A2 Gestational Diabetes - abnormal GTT, abnormal PP, abnormal FBG?

A

insulin required

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4
Q

Type I or Type II DM diagnosed anytime prior to pregnancy

A

Pregestational Diabetes

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5
Q

What do you look at to best predict the outcome in case of DM?

A

vascular involvement (nephropathy, retinopathy, HTN, arteriosclerotic heart disease)

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6
Q

fetal hyperglycemia that results in excessive fetal growth - shoulders end up wider than the head

A

macrosomia

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7
Q

What is the weight to be considered macrosomia?

A

4,000-4,500 grams

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8
Q

What are some risks associated with shoulder dystocia?

A

brachial plexus injury
fractured clavicle
fractured humerus
fetal hypoxemia

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9
Q

What is Erb’s Palsy?

A

upper arm paralysis (C5,C6)

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10
Q

What is Klumpke Palsy?

A

lower arm paralysis (C8,T1)

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11
Q

Congenital malformations associated with poorly controlled diabetes occurs when in pregnancy?

A

first 7 weeks

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12
Q

What two types of malformations are at highest risk in first 7 weeks?

A

CNS malformations and Cardiac anomalies

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13
Q

Congenital malformation that impeded the growth of the lower half of body associated with poorly controlled DM

A

sacral agenesis, caudal dysplasia, caudal regression syndrome

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14
Q

What are some of the teratogenic factors present in the mom with poorly controlled DM?

A

meternal hyperglycemia, excess ketones, excess free oxygen radicals

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15
Q

what can cause intrauterine growth restriction?

A

vascular disease (decreases uterine blood flow), preeclampsia/CHTN, pregestational DM

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16
Q

Fetal death after 36 weeks is most commonly due to

A

vascular disease, poor glycemic control, polyhydramnios, fetal macrosomia, pre-eclampsia

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17
Q

Neonatal complications common in women with poorly control DM

A

hypoglycemia, hypocalcemia, magnesium deficiency, hyperbilirubinemia, polycythemia

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18
Q

Maternal complications in women with poorly control DM

A

spontaneous abortion, pre-eclampsia, C-section, birth trauma, DKA (Type I), hypoglycemic coma, infection, postpartum hemorrhage

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19
Q

hormone produced by the placenta that modifies metabolic state of mother during pregnancy to facilitate energy supply for the fetus → promotes lipolysis and decreases glucose uptake

A

human placental lactogen (HPL) (human chorionic somatommotropin (HCS))

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20
Q

when does HPL peak in the mother? Why?

A

24-28 weeks; depends on size of placenta (may indirectly indicated poor placental function if less produced in 3rd trimester)

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21
Q

what effect does HPL have on the mother?

A

decreases maternal insulin sensitivity → increases her blood glucose levels

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22
Q

Why is it important that HPL decreases maternal glucose utilization ?

A

adequate fetal nutrition

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23
Q

If patient is unable to tolerate oral hyperosmolar glucose (N/V occurs), what are some alternatives?

A

serial glucose monitoring, fasting plasma glucose, IV GTT

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24
Q

When do you screen for diabetes in pregnancy?

A

24-28 weeks

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25
Q

what is step 1 in screening for diabetes in pregnancy?

A

give 50 gm glucose load (Glucola) → check one hour plasma glucose → want to be < 140

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26
Q

In step 1, if the plasma glucose is >140 then what is the next step?

A

3 hour GTT

27
Q

what are ACOG identified risk factors for early screening for GDM?

A

personal history of GDM, known impaired glucose metabolism, BMI > 30

28
Q

What test do you use to diagnose GDM?

A

3 hour GTT

29
Q

How many abnormal values do you need to confirm diagnosis of GDM with the 3 hours GTT?

A

two or more

30
Q

Range for abnormal value in 3 hour GTT for:

Fasting, 1 hr, 2 hr, 3 hr

A

fasting: 95-105
1 hour: 180-190
2 hour: 155-165
3 hour: 140-145

31
Q

what do you check in woman with DM prior to becoming pregnant?

A

HgbA1c, creatinine and urine protein/creatine ratio, EKG (DM > 5 years or co-morbidities, ophthalmology referral, TSH and free T4, 24 hours urine (looking for protein excretion and creatinine clearance)

32
Q

when do you want to get US in patient with pregestational DM patient? When get fetal echo?

A

20 weeks

22 weeks

33
Q

When should you get growth US in pregestational DM patient?

A

q 4 weeks starting @ 28 weeks

34
Q

Starting at 32 weeks, when should you perform antenatal testing in pregestational DM patient?

A

twice weekly

35
Q

Why should women with pregestational DM be on low dose Aspirin (81 mg) q daily?

A

reduces risk of pre-eclampsia, preterm birth, and risk of IUGR

36
Q

How should you manage the diet of pregestational DM patient?

A

2200 kcal ADA diet, 40% carb/20% protein/40% fat

37
Q

What is the therapeutic goal for fasting glucose?

A

60-90

38
Q

what is the therapeutic goal for 1 hour postprandial glucose? Goal for 2 hour post prandial?

A

< 140

< 120

39
Q

oral hypoglycemia that can be used in outpatient setting for GDM

A

glyburide

40
Q

If the therapeutic goals exceed diet and glycburide therapy soley, what can you initied next?

A

insulin therapy

41
Q

where do you start insulin therapy in patient with GDM?

A

inpatient

42
Q

What are the differences in regular and NPH insulin?

A

Regular → onset in 1/2 hour, peak in 2-4 hour, lasts 5-7 hours
NPH → onset in 1-2 hour, peak 6-12, lasts 18-24 hours

43
Q

why do you have to increase insulin dosese as pregnancy progresses?

A

insulin resistance increases as well

44
Q

what ratio of daily insulin do you get in the AM vs PM?

A

AM get 2/3 and PM get 1/3

45
Q

what do make adjustments in NPH and regular insulin based on?

A

fastin and 1 hour postprandial blood glucose

46
Q

What do you change to control AM fasting glucose?

A

PM NPH

47
Q

What do you change to control 1-2 hr PP (breakfast) glucose?

A

AM regular

48
Q

What do you change to control 1-2 hr PP (lunch) glucose?

A

AM NPH

49
Q

What do you change to control 1-2 hr PP (dinner) glucose?

A

PM regular

50
Q

You increase a patients PM NPH since their AM fasting is increase but there is not affect → what do you check next and what can be the cause?

A

3 am BS → low indicated Somogyi effect

51
Q

How do you compensate for Somogyi effect?

A

decrease PM NPH

52
Q

when is the best time to start folic acid supplementation in pregnancy?

A

prior to conception

53
Q

what is the marker for fetal lung maturity

A

PG (phosphatidylglycerol)

54
Q

What is the best way to deliver a baby in patient with well controlled DM?

A

induction @ 39 weeks → vaginal

55
Q

When should you consider C-section in pregnancy with DM?

A

EFW > 4000-4500 @ term

56
Q

For a scheduled C section how should you adjust your patients insulin the night before and in the morning of?

A

usual dose of rapid acting; decrease long lasting by 50%

hold AM insulin (patient is NPO)

57
Q

what do you want to maintain the glucose within the range of during labor?

A

70-120

<110 (ACOG)

58
Q

According to ACOG if you glucose range is between 140-180 during labor, what is this associated with?

A

neonatal hypoglycemia and increased risk of maternal ketoacidosis

59
Q

how do you manage a pregestational diabetic postpartumly?

A

resume insulin at 50% prepregnancy dose

60
Q

how do you manage a GDM patient postpartum?

A

GDM resolves after delivery

61
Q

When should you screen for diabetes following delivery?

A

6-12 weeks

62
Q

what is a sign of shoulder dystocia?

A

turtle sign

63
Q

what maneuvers can you do if there is shoulder dystocia of the baby during delivery?

A 
McRoberts position 
Suprapubic pressure
Deliver posterior arm
Woods corkscrew/Rubin
Episiotomy 
Break the clavicle 
Hands and Knees 
Zavenelli

Obstetrics (17 decks)

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