high risk pregnancy - diabetes Flashcards
what are the two types of diabetes in obstreitics ?
gestational DM
Pre existing DM
why is pregnancy diabetogenic ?
- due to the increased production of placental lactogen and placental insulinase
- due to increased insulin requirements
what are the risk factors for developing gestational diabetes ?
BMI above 30 Kg/m2
previous macrocosmic baby
previous gestational diabetes
family history of diabetes
what method is used in the diagnosis of gestational DM ?
2 hour 75 g oral glucose tolerance test
if the patient appears to be normal in her first OGTT test when should the test be repeated again ?
at 24-28 weeks
how is a diagnosis of GDM made ?
either :
1. a fasting plasma glucose of 100 mg or above
2 a 2 hour plasma glucose level of 140 mg or above
what are the maternal effects of diabetes during pregnancy ?
pregnancy induced hypertension
infections
obstructed labor due to a large sized baby
deficient lactation
what are the fetal effects of diabetes during pregnancy ?
abortions polyhydraminos congenital anomalies macrosomia preterm labour intra uterine fetal death neonatal mortality and morbidity
what is the congenital anomaly specific to gestational diabetes ?
sacral dysgenesis
why does preterm labour mainly happen ?
due to polyhydraminos
what are the common causes of intra uterine death in diabetic women?
ketosis hypoglycaemia pre eclampsia congenital anomalies placental insufficiency
how can hypoglycaemia cause intra uterine death in a diabetic pregnant woman ?
due to over treatment by medications
what are the most common causes of neonatal mortality and morbidity ?
hypoglycaemia respiratory distress syndrome congenital anomalies birth trauma hyperbilirubinemia
what advice would you give a pregnant women with diabetes ?
measure random blood glucose regular and follow up
exercise for about 30 mins everyday
change in diet
what must you do inn terms of referral when dealing with a pregnant diabetic woman ?
refer to both a dietician and an endocrinologist
what is the first line of management for a pregnant woman who has a blood glucose off 126 mg/dl or below?
trial of change in diet and exersice
if blood glucose targets are not met after change inn diet and exercise what is the next best step in management ?
add metformin if levels are not met within 1-2 weeks
if metformin is contraindicated or not well tolerated by the patient what is the best next step in management ?
add insulin
if the blood glucose level is above 126 mg/dl what is the next best step in management ?
add insulin with or without metformin
if metformin does not help meet the glucose target and insulinn is declined what should the patient take ?
glibenclamide
what advise would u give for a diabetic pregnant women being treated with insulin ?
to always have a fast acting form of glucose due to risk of hypoglycaemia with insulin
if insulin fails to maintain proper blood glucose what is the best next step in a management ?
continuous subcutaneous insulin infusion
when should pregnant women do an ultrasound to detect fetal structural abnormalities including fetal heart abnormalities ?>
week 20
how often should fetal growth and amniotic fluid volume be checked ?
every 4 weeks from 28 to 36 weeks
when should routine fetal wellbeing be checked in diabetic pregnant women ?
at 38 weeks
what method of tocolysis is contraindicated in pregnant women with diabetes?
using betamimetics
when should a woman with pre existing DM give birth ?
from 37+0 weeks to
38+6 weeks
when should a woman with GDM give birth ?
40 weeks + 6 days ( maximum length)
at what range should blood glucose be kept in a pregnant woman during labour ?
between 72 and 126 mg/dl
if the blood glucose levels are not maintained during labour what should be done ?
intravenous dextrose should be given along with insulin infusion
what postnatal care advice should women with pre existing DM take ?
if they are treated with insulin to reduce their insulin dose immediatley after birth
if she is on metformin, to continue her metformin
what advice to give pre existing DM women after labour?
to avoid oral hypoglycemics during breast feeding but can continue immediately after birth
if a woman comes into the gynaecology clinic complaining of chest pain what is the first best thing to perform ?
an ECG
what is the most common cause of valvular heart disease in egypt ?
rheumatic heart disease
what is the most common valvular heart lesion ?
mitral valve lesions
what is a key factor in most cases of aortic dissection ?
systolic hypertension
what is the most common serious complication of Marfan’s syndrome ?
aortic dissectio n
what is the gold standard for the diagnosis of aortic dissection ?
CT
if a woman has T1DM what should be given on the onset of labour ?
intravenous dextrose and insulin infusion
