Labor & Delivery - Concurrent Disorders During Pregnancy - Unit 2 (Class) Flashcards
What are the classic symptoms of diabetes?
Polydipsia, polyuria, polyphagia
Early pregnancy DM - causes?
Small change in maternal metabolic need, insulin release in response to serum glucose levels… hypoglycemia can happen.
Late pregnancy - DM?
Fetal growth accelerates, rise in placental hormone levels, hormones create resistance to insulin.
Birth - DM info
Maintenance of normal maternal glucose levels is essential during birth to reduce neonatal hypoglycemia.
Insulin acts like a growth hormone for bambinos, so that’s why diabetes babies can be so ___.
Big
What is GDM?
Gestational Diabetes Mellitus
Diabetes Mellitus - preeclampsia is __ to __ times more likely to develop, along with ___ and spontaneous ___.
2-3 times.
preeclampsia and spontaneous abortion.
What are some neonatal effects of DM?
Hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome.
DM - can they do oral agents?
Nope, mainly insulin.
What are parts of the physical exam for DM? Lab tests?
ECG, opthalmology referral, height/weight/BP
24 hr urine and AIC
DM - fetal assessment - what? when?
Surveillance should be begin EARLY - testing for anomalies, ultrasounding frequently, fetal kick count, echo (make sure babies heart is okay)
How do we manage DM?
Maintain normal BG levels, avoid accelerated impairment of blood vessels and other major organs, preconception care, diet, self-monitoring of glucose, insulin therapy, etc.
What are some risk factors for gestational diabetes mellitus?
Overweight, maternal age greater than 25 years old, previous birth outcome often associated with GDM, previous GDM, family history of diabetes, abnormal glucose tolerance, member of a high-risk ethnic group, etc.
How do we screen for GDM?
1 hour test (50 g of oral glucose shit),
If abnormal, 3 hour glucose test (OGTT) with 100 g of the shit.
Oral glucose challenge test - numbers for fasting, 1 hr, 2 hours, 3 hours.
fasting = greater then 95
1 hour = greater than 180
2 hours = greater then 155
3 hours = greater than 140
How do we manage GDM?
diet (dietician, educator, etc), nonobese prepregnancy weight - 30 kcal/kg/day is recommended - obeses = 25kcal/day, exercise, blood glucose monitoring, fetal surveillance
Cardiac disease - heart disease complicates about 1% of pregnancies. T/F?
True
What are the two major categories of heart disease?
Rheumatic and congenital
Rheumatic heart disease - what can cause it? Common site? May lead to???
Streptococcal pharyngitis can cause it.
RHD may cause scarring of the heart vessels - typically mitral valve.
May lead to pulmonary hypertension, pulmonary edema, or congestive heart failure.
Congenital heart disease - left to right shunt. What is it?
Arterial septal defect, ventricular septal defect, patent ductus arteriosus
congenital heart disease - right to left shunt - what is it?
Tetralogy of fallot (4 rare defects), eisenmenger’s syndrome (untreated cardiac stuff)
With heart stuff for mom, what is our focus?
Keeping her safe and finding the farthest point we can go to - like “can she safely make it to 32 weeks? 34 weeks? etc.”
“You have a patient with rheumatic heart disease, which symptom would you be worried about?”
Rales!!!!
what are some symptoms of heart disease?
dyspnea, syncope, hemoptysis, paroxysmal nocturnal dyspnea, chest pain with exertion, additional signs, etc.
300-500 ml of blood is shifted from the uterus and placenta into the central circulation. T/F?
True
Vaginal delivery - NOT recommend for a woman with heart disease. T/F?
FALSE - it is (unless otherwise indicated)
Workload of heart increases AFTER birth because of the blood that is going back to mom. T/F?
True
Watch for signs of CHF in postpartum - T/F?
True (includes cough, progressive dyspnea, orthopnea, heart palpitations, progressive fatigue/syncope, rales, etc.
Thalassemia - what is it?
Vitamin B deficiency
Treat anemia’s as they present - T/F?
True - like iron deficiency? given iron.
Do things like systemic lupus erythematosus, antiphospholipid syndrome, hashimoto’s thyroiditis, rheumatoid arthritis, seizures, bell’s palsy…get better or worse with pregnancy?
Sometimes better!
but with seizures, they can still occur, so watch for risk of falling!
Cytomegalovirus - where does it come from?
Cat litter box - so get the automatic one.
Rubella - can they get the MMR vaccine?
Not while pregnant- it’s a live virus. So no pregnancy for 3-6 months after, as well.
Varicella zoster virus - what is it?
Chicken pox…..don’t want it during pregnancy, can cause major issues. get the vaccine!
HIV - worried about baby?
Yes….antiviral meds are important. But still can be breastfed, just check viral load!
toxoplasmosis - common during pregnancy?
yes
TB moms - can get pregnant?
Yes…just use normal precautions you would for TB!
