high risk pregnancy - diabetes

Question 1

what are the two types of diabetes in obstreitics ?

Answer 1

gestational DM

Pre existing DM

Question 2

why is pregnancy diabetogenic ?

Answer 2

1. due to the increased production of placental lactogen and placental insulinase
2. due to increased insulin requirements

Question 3

what are the risk factors for developing gestational diabetes ?

Answer 3

BMI above 30 Kg/m2
previous macrocosmic baby
previous gestational diabetes
family history of diabetes

Question 4

what method is used in the diagnosis of gestational DM ?

Answer 4

2 hour 75 g oral glucose tolerance test

Question 5

if the patient appears to be normal in her first OGTT test when should the test be repeated again ?

Answer 5

at 24-28 weeks

Question 6

how is a diagnosis of GDM made ?

Answer 6

either :
1. a fasting plasma glucose of 100 mg or above
2 a 2 hour plasma glucose level of 140 mg or above

Question 7

what are the maternal effects of diabetes during pregnancy ?

Answer 7

pregnancy induced hypertension
infections
obstructed labor due to a large sized baby
deficient lactation

Question 8

what are the fetal effects of diabetes during pregnancy ?

Answer 8

abortions 
polyhydraminos 
congenital anomalies 
macrosomia 
preterm labour 
intra uterine fetal death 
neonatal mortality and morbidity

Question 9

what is the congenital anomaly specific to gestational diabetes ?

Answer 9

sacral dysgenesis

Question 10

why does preterm labour mainly happen ?

Answer 10

due to polyhydraminos

Question 11

what are the common causes of intra uterine death in diabetic women?

Answer 11

ketosis 
hypoglycaemia 
pre eclampsia 
congenital anomalies 
placental insufficiency

Question 12

how can hypoglycaemia cause intra uterine death in a diabetic pregnant woman ?

Answer 12

due to over treatment by medications

Question 13

what are the most common causes of neonatal mortality and morbidity ?

Answer 13

hypoglycaemia 
respiratory distress syndrome 
congenital anomalies 
birth trauma 
hyperbilirubinemia

Question 14

what advice would you give a pregnant women with diabetes ?

Answer 14

measure random blood glucose regular and follow up
exercise for about 30 mins everyday
change in diet

Question 15

what must you do inn terms of referral when dealing with a pregnant diabetic woman ?

Answer 15

refer to both a dietician and an endocrinologist

Question 16

what is the first line of management for a pregnant woman who has a blood glucose off 126 mg/dl or below?

Answer 16

trial of change in diet and exersice

Question 17

if blood glucose targets are not met after change inn diet and exercise what is the next best step in management ?

Answer 17

add metformin if levels are not met within 1-2 weeks

Question 18

if metformin is contraindicated or not well tolerated by the patient what is the best next step in management ?

Answer 18

add insulin

Question 19

if the blood glucose level is above 126 mg/dl what is the next best step in management ?

Answer 19

add insulin with or without metformin

Question 20

if metformin does not help meet the glucose target and insulinn is declined what should the patient take ?

Answer 20

glibenclamide

Question 21

what advise would u give for a diabetic pregnant women being treated with insulin ?

Answer 21

to always have a fast acting form of glucose due to risk of hypoglycaemia with insulin

Question 22

if insulin fails to maintain proper blood glucose what is the best next step in a management ?

Answer 22

continuous subcutaneous insulin infusion

Question 23

when should pregnant women do an ultrasound to detect fetal structural abnormalities including fetal heart abnormalities ?>

Answer 23

week 20

Question 24

how often should fetal growth and amniotic fluid volume be checked ?

Answer 24

every 4 weeks from 28 to 36 weeks

Question 25

when should routine fetal wellbeing be checked in diabetic pregnant women ?

Answer 25

at 38 weeks

Question 26

what method of tocolysis is contraindicated in pregnant women with diabetes?

Answer 26

using betamimetics

Question 27

when should a woman with pre existing DM give birth ?

Answer 27

from 37+0 weeks to

38+6 weeks

Question 28

when should a woman with GDM give birth ?

Answer 28

40 weeks + 6 days ( maximum length)

Question 29

at what range should blood glucose be kept in a pregnant woman during labour ?

Answer 29

between 72 and 126 mg/dl

Question 30

if the blood glucose levels are not maintained during labour what should be done ?

Answer 30

intravenous dextrose should be given along with insulin infusion

Question 31

what postnatal care advice should women with pre existing DM take ?

Answer 31

if they are treated with insulin to reduce their insulin dose immediatley after birth
if she is on metformin, to continue her metformin

Question 32

what advice to give pre existing DM women after labour?

Answer 32

to avoid oral hypoglycemics during breast feeding but can continue immediately after birth

Question 33

if a woman comes into the gynaecology clinic complaining of chest pain what is the first best thing to perform ?

Answer 33

an ECG

Question 34

what is the most common cause of valvular heart disease in egypt ?

Answer 34

rheumatic heart disease

Question 35

what is the most common valvular heart lesion ?

Answer 35

mitral valve lesions

Question 36

what is a key factor in most cases of aortic dissection ?

Answer 36

systolic hypertension

Question 37

what is the most common serious complication of Marfan’s syndrome ?

Answer 37

aortic dissectio n

Question 38

what is the gold standard for the diagnosis of aortic dissection ?

Answer 38

CT

Question 39

if a woman has T1DM what should be given on the onset of labour ?

Answer 39

intravenous dextrose and insulin infusion