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Y4R2 - Obstetrics I 🤰 > L13: DM in Pregnancy > Flashcards

L13: DM in Pregnancy Flashcards

1
Q

Def of DM

A

Chronic metabolic disorder in CHO metabolism è impact on fat & protein metabolism due to insulin dysfunction (deficiency or resistance).

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2
Q

Def of GDM

A

DM firstly discovered during current pregnancy

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3
Q

Def of DM in Pregnancy

A

Gestational DM + pregnancy in patients known to be diabetic

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4
Q

Incidence of DM in Pregnancy

A

2-5% of all pregnancies (80-90% are GDM)

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5
Q

Stages of DM

A
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6
Q

WHO Classification of DM

A
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7
Q

Modified White Classification of DM in Pregnancy

A
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8
Q

Modified White Classification of DM in Pregnancy

  • A1 & A2
A
  • A1: → FBS < 105 mg/d| & PPS < 120 mg/di.
    A2: → FBS > 105 mg/dl & PPS > 120 mg/dl.
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9
Q

RF for GDM

A
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10
Q

Effects of Pregnancy on DM

A
  • Pregnancy is Diabetogenic
  • Change in Insulin Requirments
  • Increased Incidence of DM Complications
  • Aggravation of Retinopathy & Nephropathy
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11
Q

Clinical diabetes may appear for 1st time during pregnancy (GDM) due to …..

A
  • Anti-insulin effect of pregnancy hormones (as HPL, estrogen & progesterone).
  • Increased peripheral insulin resistance.
  • Secretion of insulinase enzyme by placenta.
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12
Q

Effects of Pregnancy on DM

  • Pregnancy is Diabetogenic
A
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13
Q

Effects of Pregnancy on DM

  • Change in Insulin Requirments
A
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14
Q

Effects of Pregnancy on DM

  • Increased incidence of DM Complications
A
  • Hypoglycemia: Blood glucose level < 60 mg/dI.
  • Diabetic ketoacidosis (DKA).
  • Starvation ketosis.
  • Diabetic comas: Hyperglycemic or hypoglycemic.
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15
Q

Effects of Pregnancy on DM

  • Aggravation of Retinopathy & Nephropathy
A

…

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16
Q

Effects of DM on Pregnancy

A

Maternal & Fetal & Neonatal

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17
Q

Maternal Effects of DM on Pregnancy

A
  • During Pregnancy
  • During labor
  • During Puerperium
  • Late Complications
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18
Q

Maternal Effects of DM on Pregnancy

  • Abortion
A

Due to Ag-Ab reaction associating DM or chromosomal abnormalities.

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19
Q

Maternal Effects of DM on Pregnancy

  • Preterm Labor
A

3-4 times higher in diabetics (MgSO4 is the tocolytic of choice).

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20
Q

Maternal Effects of DM on Pregnancy

  • Polyhydraminos
A
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21
Q

Maternal Effects of DM on Pregnancy

  • HTN
A

Due to vasculopathy or nephropathy.

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22
Q

Maternal Effects of DM on Pregnancy

  • Infection
A

UTI, vulvovaginitis (monilia) or chorioamnionitis (after ROM).

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23
Q

Maternal Effects of DM on Pregnancy

  • During Pregnancy
A
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24
Q

Maternal Effects of DM on Pregnancy

  • During Labor
A
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25
Q

Maternal Effects of DM on Pregnancy

  • During puerperium
A
  1. PPH & puerperal sepsis.
  2. Abnormal lactation: Due to changes in glucose level.
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26
Q

Maternal Effects of DM on Pregnancy

  • Late Complications
A

50% of cases è GDM will develop overt DM later on.

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27
Q

Neonatal Effects of DM on Pregnancy

A
  • Respiratory distress syndrome (RDS)
  • Hypertrophic cardiomyopathy
  • Hypoglycemia
  • Hypocalcemia & hypomagnesemia
  • Hyperbilirubinemia
  • Polycythemia
  • Poor Feeding
  • Birth Trauma
  • Late Complications
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28
Q

Neonatal Effects of DM on Pregnancy

  • RDS
A
  • Due to delayed lung maturity (because hyperinsulinemia inhibits secretion of pulmonary surfactant).
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29
Q

Neonatal Effects of DM on Pregnancy

  • Hypoglycemia
A

Blood glucose level < 40 mg/d| (due to hyperinsulinemia)

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30
Q

Neonatal Effects of DM on Pregnancy

  • Hyperbilirubenemia
A

Due to delay in liver maturation.

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31
Q

Neonatal Effects of DM on Pregnancy

  • Polycythemia
A

Hct value > 65% (due to chronic intrauterine hypoxia → T T erythropoietin production).

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32
Q

Neonatal Effects of DM on Pregnancy

  • Poor Feeding
A

Due to prematurity, RDS or congenital anomalies

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33
Q

Neonatal Effects of DM on Pregnancy

  • Late Complications
A

Increased risk of development of type I DM later in life (1-3% if mother only is diseased & 6% if father is diseased also

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34
Q

Fetal Effects of DM on Pregnancy

A
  • Congenital Anomalies
  • Macrosomia
  • IUGR
  • IUFD
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35
Q

Fetal Effects of DM on Pregnancy

  • Congenital Anomalies
A
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36
Q

Most Common Congenital Anomalies in pregnancy with DM

A

Specially VSD

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37
Q

Most Specific Congenital Anomalies in Pregnancy in DM

A

Sacral agenesis (caudal regression or caudal dysplasia)

38
Q

Fetal Effects of DM on Pregnancy

  • Macrosomia
39
Q

Etiology of Macrosomia in DM in Pregnancy

40
Q

Prevention of Macrosomia in DM in Pregnancy

A

Strict diabetic control before 2nd trimester.

41
Q

Fetal Effects of DM on Pregnancy

  • IUGR
A

Due to chronic placental insufficiency (due to vasculopathy).

42
Q

Fetal Effects of DM on Pregnancy

  • IUFD
43
Q

Theories of Unexplained IUFD

44
Q

Dx of DM in Preegnancy

  • Hx
45
Q

Dx of DM in Preegnancy

  • Ex
A

Signs of complications (maternal or fetal).

46
Q

Dx of DM in Preegnancy

  • Investigations
A
  • Test for glucosuria
  • Oral glucose tolerance tests (OGTTs)
  • Glycosylated HbA1 (HbA1c)
  • Investigations to detect complications
47
Q

Investigations for DM in pregnancy

48
Q

Investigations for DM in pregnancy

  • Glucosuria
A

Done in each ANC visit & if +ve → blood investigations.

49
Q

Investigations for DM in pregnancy

  • OGTT
A
  • 50gm 1-hour OGTT
  • 100 gm 3-hours OGTT
50
Q

Best Screening Test in DM with Pregnancy

A

50gm 1-hour OGTT

51
Q

50gm 1-hour OGTT

52
Q

The gold standard for diagnosis of GDM

A

100 gm 3-hours OGTT

53
Q

100 gm 3-hours OGTT

54
Q

Investigations for DM in pregnancy

  • HbA1c
55
Q

Investigations for DM in pregnancy

  • To Detect Complications
A

Maternal & fetal

56
Q

Managment Aspects of DM in Pregnancy

A
  • Pre-Conceptional care
  • Managment During pregnancy
  • Managment of Delivery
  • Neonatal care
  • Postnatal care
57
Q

Managment of DM in Pregnancy

  • Pre-Conceptional Care
58
Q

Pre-Conceptional Care for DM in Pregnancy

59
Q

ANC for DM in Pregnancy

60
Q

ANC for DM in Pregnancy

  • Frequency of Visits
61
Q

Glycemic Control for DM in Pregnancy

A
  • Dietary recommendation
  • Insulin therapy
62
Q

Glycemic Control for DM in Pregnancy

  • Dietary Recommendations
63
Q

Dietary Recommendations for control of DM in Pregnancy

  • Total Caloric Intake
A
  • 30 calories/kg/day → (for patients è ideal body weight)
    Total caloric intake:
  • 24 calories/kg/day → (for obese patients).
64
Q

Dietary Recommendations for control of DM in Pregnancy

  • Components of Diet
A

35-55% CHO, 25% proteins & 20% fat.

65
Q

Dietary Recommendations for control of DM in Pregnancy

  • No of meals per day
A

In type 1DM= 6 meals/day (3 meals + 3 snacks in () meals).
Number of meals/day:

  • In type Il DM & GDM= 4 meals/day (3 meals + bed time snack).
66
Q

Glycemic Control for DM in Pregnancy

  • Insulin Therapy
A

The standard treatment for DM è pregnancy.

67
Q

Insulin Therapy for DM in Pregnancy

68
Q

Insulin Therapy for DM in Pregnancy

  • Goals
A

Keeping FBS < 105 mg/dl & 2 hours PPS < 120 mg/di.

69
Q

Insulin Therapy for DM in Pregnancy

  • Insulin Preparations
A

Ultrashort, short, intermediate & long acting.

70
Q

Insulin Therapy for DM in Pregnancy

  • Routes of adminstration
71
Q

Insulin Therapy for DM in Pregnancy

  • Calculation of dose
A

In 1st half of pregnancy: → Body weight x 0.6 units/day.

In 2nd half of pregnancy: → Body weight x 0.7 units/day.

72
Q

Insulin Therapy for DM in Pregnancy

  • regimens
73
Q

Glycemic Control for DM in Pregnancy

  • Oral Hypoglycemic Drugs
74
Q

Oral Hypoglycemic Drugs aren’t recommended & usually avoided during pregnancy because: ……

A
  1. They cross placenta leading to:
    * Fetal teratogenic effects (most commonly in ear).
    * Severe neonatal hypoglycemia.
  2. Tight glycemic control è them is difficult.
75
Q

Managment Aspects of DM in Pregnancy

  • Maternal Observation
76
Q

Managment Aspects of DM in Pregnancy

  • fetal Observation
77
Q

Time of Delivery for A1 GDM

A

At 40 weeks (EDD)

78
Q

Time of Delivery for GDM Other than A1

A

At 38 weeks

79
Q

When to deliver at >37 weeks in GDM?

80
Q

Prerequisites before induction of lobor in DM in Pregnancy

81
Q

Precautions in Vaginal delivery DM in Pregnancy

82
Q

CS in DM in Pregnancy

A

DM not indication for CS → ass. è increased incidence of CS (CS rate reaches 47%).

83
Q

Indications of CS in DM in Pregnancy

84
Q

Precautions of CS in DM in Pregnancy

A
  • Glycemic control.
  • Prophylactic antibiotics.
  • Anesthesia: General anesthesia is the standard.
85
Q

Neonatal Care in DM in Pregnancy

86
Q

Postnatal Care in DM in Pregnancy

87
Q

Postnatal Care in DM in Pregnancy

  • Prophylactic Antibiotic
A

Because these cases are more liable to infection.

88
Q

Postnatal Care in DM in Pregnancy

  • Nutritive Fluids
A

Encourage patient to take highly nutritive light fluids.

89
Q

Postnatal Care in DM in Pregnancy

  • Insulin Dose
A

Adjust insulin dose: Usually decrease by 1/3 (keep on hyperglycemic side).

90
Q

Postnatal Care in DM in Pregnancy

  • Breast Feeding
A

Encourage breast feeding.

91
Q

Postnatal Care in DM in Pregnancy

  • Contraceptive advice
92
Q

Perinatal Mortality in DM in Pregnancy

A

2-5% (50% of them are due to congenital anomalies).

Y4R2 - Obstetrics I 🤰 (59 decks)

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