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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
what is step 1 in screening for diabetes in pregnancy?
give 50 gm glucose load (Glucola) → check one hour plasma glucose → want to be < 140
26
In step 1, if the plasma glucose is >140 then what is the next step?
3 hour GTT
27
what are ACOG identified risk factors for early screening for GDM?
personal history of GDM, known impaired glucose metabolism, BMI > 30
28
What test do you use to diagnose GDM?
3 hour GTT
29
How many abnormal values do you need to confirm diagnosis of GDM with the 3 hours GTT?
two or more
30
Range for abnormal value in 3 hour GTT for: | Fasting, 1 hr, 2 hr, 3 hr
fasting: 95-105 1 hour: 180-190 2 hour: 155-165 3 hour: 140-145
31
what do you check in woman with DM prior to becoming pregnant?
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
when do you want to get US in patient with pregestational DM patient? When get fetal echo?
20 weeks | 22 weeks
33
When should you get growth US in pregestational DM patient?
q 4 weeks starting @ 28 weeks
34
Starting at 32 weeks, when should you perform antenatal testing in pregestational DM patient?
twice weekly
35
Why should women with pregestational DM be on low dose Aspirin (81 mg) q daily?
reduces risk of pre-eclampsia, preterm birth, and risk of IUGR
36
How should you manage the diet of pregestational DM patient?
2200 kcal ADA diet, 40% carb/20% protein/40% fat
37
What is the therapeutic goal for fasting glucose?
60-90
38
what is the therapeutic goal for 1 hour postprandial glucose? Goal for 2 hour post prandial?
< 140 | < 120
39
oral hypoglycemia that can be used in outpatient setting for GDM
glyburide
40
If the therapeutic goals exceed diet and glycburide therapy soley, what can you initied next?
insulin therapy
41
where do you start insulin therapy in patient with GDM?
inpatient
42
What are the differences in regular and NPH insulin?
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
why do you have to increase insulin dosese as pregnancy progresses?
insulin resistance increases as well
44
what ratio of daily insulin do you get in the AM vs PM?
AM get 2/3 and PM get 1/3
45
what do make adjustments in NPH and regular insulin based on?
fastin and 1 hour postprandial blood glucose
46
What do you change to control AM fasting glucose?
PM NPH
47
What do you change to control 1-2 hr PP (breakfast) glucose?
AM regular
48
What do you change to control 1-2 hr PP (lunch) glucose?
AM NPH
49
What do you change to control 1-2 hr PP (dinner) glucose?
PM regular
50
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?
3 am BS → low indicated Somogyi effect
51
How do you compensate for Somogyi effect?
decrease PM NPH
52
when is the best time to start folic acid supplementation in pregnancy?
prior to conception
53
what is the marker for fetal lung maturity
PG (phosphatidylglycerol)
54
What is the best way to deliver a baby in patient with well controlled DM?
induction @ 39 weeks → vaginal
55
When should you consider C-section in pregnancy with DM?
EFW > 4000-4500 @ term
56
For a scheduled C section how should you adjust your patients insulin the night before and in the morning of?
usual dose of rapid acting; decrease long lasting by 50% | hold AM insulin (patient is NPO)
57
what do you want to maintain the glucose within the range of during labor?
70-120 | <110 (ACOG)
58
According to ACOG if you glucose range is between 140-180 during labor, what is this associated with?
neonatal hypoglycemia and increased risk of maternal ketoacidosis
59
how do you manage a pregestational diabetic postpartumly?
resume insulin at 50% prepregnancy dose
60
how do you manage a GDM patient postpartum?
GDM resolves after delivery
61
When should you screen for diabetes following delivery?
6-12 weeks
62
what is a sign of shoulder dystocia?
turtle sign
63
what maneuvers can you do if there is shoulder dystocia of the baby during delivery?
``` 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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