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Adv Midwifery Childbearing > Mod 5-6 > Flashcards

Mod 5-6 Flashcards

1
Q 
Associated Risk Factors for \_\_\_\_\_:
Preeclampsia
Macrosomia
Chronic Type II GDM
Stillbirth
Shoulder Dystocia
Neonatal Hypoglycemia
A

GDM

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2
Q

Always check these things in GDM patient

A

fundal height + kick counts

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3
Q

If 1 hr screen is >_____, do not do 3 hr GTT because patient is diagnosed with GDM.

A

200

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4
Q

number of times to tell GDM patient to check blood sugar

A

4x- fasting and 2 hrs after each meal

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5
Q

If no _________ are present, the patient may decline GDM screening.

A

risk factors

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6
Q

In the 3 hour GTT, ___ results must be elevated in order to diagnose GDM

A

two (2)

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7
Q

If GDM is diagnosed, the first step is:

A

diet and lifestyle modifications

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8
Q

EARLY 1 hr GDM screen:

GDM diagnosis is made if result is >_____

A

140

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9
Q

If early screen is normal, still order ________ @ _____ weeks

A

1 hr GTT @ 24-28 weeks

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10
Q

first line treatment for GDM management when diet therapy alone has not worked

A

insulin

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11
Q

Does insulin cross the placenta?

A

No

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12
Q

reasonable alternative for GDM patients who cannot take insulin or decline it

A

Metformin

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13
Q

gestational age of diagnosis that means diabetes is gestational and NOT pregestational

A

24

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14
Q

If EARLY GDM screen is elevated (>140), midwife should:

A

order 3 hr GTT

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15
Q

With diet-controlled GDM, recommendation for delivery is expectant management until:

A

40.6 weeks

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16
Q

With insulin-dependent GDM, recommendation for delivery is induction at:

A

39.0-39.6 weeks

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17
Q

If 1 hr and 3 hr GTT are all abnormal, the midwife should:

A

screen for Type II DM in the PP period

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18
Q

for PP GDM screening, use:

A

75 gm, 2 hr GTT

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19
Q

study algorithm for glucose in neonates!

A

put in the cards

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20
Q

hydatidiform mole, gestational trophoblastic disease

A

molar pregnancy

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21
Q 
Treatment for \_\_\_\_\_\_\_\_\_\_\_:
check dates
maybe repeat US
check for rising hCG
wait for miscarriage vs D&C or aspiration
A

blighted ovum

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22
Q

Treatment for ___________:
D&C
follow hCG for until level is 0 (may take 6 mo-1 year)
delay subsequent pregnancy for at least 6 months after hCG is 0

A

molar pregnancy

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23
Q

anembryonic pregnancy (empty sac)

A

blighted ovum

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24
Q

poor quality sperm or egg, wrong # of chromosomes causes this:

A

blighted ovum

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25
Q

sometimes called a “chemical pregnancy”

A

blighted ovum

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26
Q

causes hCG rises slowly and stay low (patient may have no symptoms and may miscarry without knowing it)

A

blighted ovum

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27
Q

chromosomal error- all from father or 2 sets from father and only 1 from mother (too many chromosomes from father)

A

molar pregnancy

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28
Q 
Symptoms of \_\_\_\_\_\_\_\_\_\_:
bleeding/spotting
usually size>dates on US
extra pregnancy symptoms
hyperemesis severe
A

molar pregnancy

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29
Q

fetus size for which clinical palpation is most accurate for estimating fetal weight

A

2500-4000 gm

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30
Q

SGA is diagnosed by:

A

a weight scale

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31
Q

Size

A

fundal height

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32
Q

IUGR is diagnosed by:

A

Ultrasound

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33
Q

normal deepest vertical pocket for amniotic fluid

A

> 2 cm

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34
Q

normal AFI

A

5-20 cm

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35
Q

complete loss of flow in the umbilical artery (from fetus to placenta) during diatole = abnormal flow = ill baby

A

absent end diastole flow

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36
Q

blood flows backwards from placenta to umbilical artery = very ill baby = needs to be delivered NOW

A

reversed end diastolic flow

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37
Q

A1GDM

A

diet-controlled GDM

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38
Q

A2GDM

A

medication-dependent GDM

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39
Q

before ___ weeks, cells are MORE responsive to insulin so blood sugar may be lower than normal

A

20

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40
Q

As placenta grows, human placental lactogen (hPL) and other diabetogenic hormones ______________ which creates cellular resistance to insulin causing BG to rise

A

increase

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41
Q

peak effect of hPL is at ___-___ weeks, which is why we screen for GDM at this gestation

A

26-28

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42
Q

incidence of GDM in U.S. ___-___%

A

3-9%

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43
Q

Higher incidence of GDM in these populations

A

Hispanic, African American, Native American, Asian, and Pacific Islander

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44
Q

Risk Factors for _____________:
–Non-modifiable
Increased age, >/=40
Race/Ethnicity - Hispanic, African American, Native American, Asian, and Pacific Islander
Medical Hx of GDM, impaired glucose metabolism, glycosuria, PCOS, HTN, CVD, A1C >/= 5.7%, Lipids - HDL < 35, triglyceride > 250, acanthosis nigricans
Meds that increase BG
Family Hx of Type 2 DM- especially 1st degree relatives
Obstetric Hx - previous GDM, infant >/= 4000g, stillbirth, congenital anomalies
–Modifiable
Weight gain - pre-pregnancy, early adulthood, gestational, between pregnancies
Obesity - higher BMI, prepreg BMI >40
Sedentary lifestyle

A

GDM

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45
Q

Factors that lower risk for _________:
No known diabetes in 1st degree relatives
Age < 25
Weight normal before pregnancy, at birth
No hx of abnormal glucose metabolism
No hx of poor obstetrical outcome
Ethnicity with lower prevalence of GDM - caucasian

A

GDM

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46
Q

Increase of risk for _______ after pregnancy:
10% in the first months postpartum
50% by 5 years
70% by 10+ years

A

GDM

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47
Q

Fetal Implications of _________:
**Increased risk w/ poor glycemic control
Anomalies - If DM predates pregnancy and was undiagnosed/not controlled– significant risk
IUFD
jaundice
hypoglycemia
hyperbilirubinemia
shoulder dystocia
Macrosomia
Birth trauma- body changes can change hip/waist ratio “football shoulders”

A

GDM

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48
Q 
Neonatal Implications of \_\_\_\_\_\_:
NICU admission
Long-term-- 
risk for developing childhood obesity
type 2 diabetes
metabolic syndrome
Short-term-- 
respiratory distress syndrome
metabolic complications
hypoglycemia
A

GDM

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49
Q

________ Screening Approaches for women with GDM Risk Factors:
HbA1c
Fasting glucose
75 gram glucose load w/ 2 hr postprandial

A

1st Trimester

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50
Q

__________ Approach for GDM Testing:

  1. Screen w/ 50 gram 1 hr glucose challenge (w/o fasting)
    - -If blood glucose elevated beyond practices/guidelines values…
  2. Diagnosis made by 3 hr GTT
A

Two-Step

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51
Q

Glucose load of 50 grams (w/o fasting)
Results >/= ______-______ @ 1 hr
Move to diagnostic 3 hr GTT

A

130-140

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52
Q 
Carpenter/Coustan Threshold Values
100 gm glucose load
Fasting >/= \_\_\_\_
@ 1 hr >/= \_\_\_\_
@ 2 hr >/= \_\_\_\_
@ 3 hr >/= \_\_\_\_
A

95
180
155
140

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53
Q

GDM is diagnosed in the 3 hr GTT with ____ or more abnormal values

A

two or more

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54
Q 
NDDG Threshold Values
100 gm glucose load
Fasting >/= \_\_\_\_
@ 1hr >/= \_\_\_\_
@ 2 hr >/= \_\_\_\_
@ 3 hr >/= \_\_\_\_
A

105
190
165
145

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55
Q 
\_\_\_\_\_\_\_\_\_\_ Approach for GDM Testing:
75 gm glucose load
Fasting >/= 92
@ 1hr >/= 180
@ 2 hr >/= 153
56
Q 
One-Step Approach for GDM Testing:
75 gm glucose load
Fasting >/= \_\_\_\_
@ 1hr >/= \_\_\_\_
@ 2 hr >/= \_\_\_\_
57
Q

GDM is diagnosed in the One-Step approach with ____ or more abnormal values

A

one or more

58
Q 
Reasons for \_\_\_\_\_\_\_\_\_\_\_:
BMI > 25
Asian + BMI >23
AND one additional risk factor:
HTN
PCOS
Hx GDM
Hx macrosomic infant
1st degree relative w/ DM
A

1st Trimester GDM Screening

59
Q

_____________ Screen for GDM:
50 gm glucose (fasting)
BG tested @ 1 hr

A

24-28 Week

60
Q

Patient is at risk for GDM if 24-28 Weeks Screen 1 hr value is >/= ____-____

A

140 (13-18% of positive tests capture 80% of GDM)

61
Q 
\_\_\_\_\_\_\_\_\_\_\_ Screening for GDM:
Do not screen:
Age < 25
If NOT Hispanic, AA, Native American, East Asian, Pacific Islander
BMI < 25
Negative abnormal glucose intolerance
Negative Hx adverse OB outcomes
Negative 1st degree relative w/ DM
(Sensitivity 84%, Specificity 72%)
62
Q 
Diagnostic for \_\_\_\_\_\_\_\_:
1st PNV: 
FBG (fasting BG) >/= 126
RPG (random BG) >/= 200 with HbA1c confirmation
HbA1c >/= 6.5
63
Q

Diagnostic for ________:
1st PNV:
FBG (fasting BG) >/= 92 but < 126

64
Q

If 1st PNV GDM screen is normal, midwife should:

A

screen again at 24-28 weeks

65
Q

75 gm 2-hr GTT
FBG (fasting BG) >/= ____
@ 1 hr >/= _____
@ 2 hr >/= _____

66
Q

Why does ACOG support a 2-step testing vs. 1-step?

A

It increases the number diagnosed GDM w/o improvement in outcomes

67
Q

ACOG Requirement for ________ GDM Screening:
Consider if overweight or obese w/ BMI > 25; Asian-Americans BMI > 23 PLUS 1 or more of following:
-Physical inactivity
-1st degree relative with DM
-High risk race/ethnicity - African/Asian/Native American, Latino, Pacific Islander
-Hx of infant >/= 4000gm (9 lbs)
-Hx of GDM
-Hx CVD
-HTN - 140/90 or hypertension therapy
-Lipids - HDL<35; triglyceride >250
-PCOS
-HbA1C >/= 5.7%
-impaired glucose tolerance
-impaired fasting glucose on previous testing
-Other conditions associated w/insulin resistance (i.e. pre-pregnancy BMI > 40, acanthosis nigricans)

68
Q

May newly diagnosed GDM patients be cared for by midwife?

A

yes, if controlled with diet and exercise

69
Q

GDM NOT controlled by diet/exercise and controlled Type 2 DM is within midwifery scope of practice along with:

A

collaboration w/ MD

70
Q

Referral is indicated for ______ DM or Type ___ DM

A

overt; Type 1

71
Q

Normal weight patients need _____ kcal/kg

72
Q

Overweight patients need ____ kcal/kg

73
Q

Diet should be ______% carbohydrates
_____% protein
_____% fat

A

33-40% carbs
20-30% protein
40% fats

74
Q

GDM patient should keep ___________ for several weeks after dx to help assess dietary control - in conjunction w/ dietician

A

diet diary

75
Q

GDM should check BG levels _______ and ___-___ hour postprandial levels daily

A

fasting; 1-2 hours postprandial

76
Q

BG level check @ home should be:
Fasting = ____
Postprandial 1 hour = ____
Postprandial 2 hour (more commonly used) = ____

77
Q

First/Best choice for GDM medication

78
Q

These meds can be added to insulin if needed for GDM patients

A

Metformin (first), Glyburide

79
Q

If medications are required for GDM patient, midwife needs to involve:

80
Q

Medication:
Does not cross placenta
Can achieve tight control
Physician managed - midwives can continue to collaborate for other areas of care

81
Q

1st line PO med for GDM (due to better outcomes)
**Sometimes supplemental insulin still needed
Better compliance than insulin
Reasonable alternative if patient unable to safely administer/afford insulin
**Crosses placenta
Usually start at 500mg QHS for 1 week then increase to 500mg BID
Max dose 2500-3000mg/day in 2-3 divided doses
Contraindicated in chronic renal disease - check baseline creatinine
Adverse effects - abdominal pain, diarrhea

82
Q 
Studies \_\_\_\_\_\_\_\_\_\_\_\_\_ show
maternal weight gain
increase in PTB
less severe neonatal hypoglycemia
Less NICU admits
A

Metformin to Insulin

83
Q

Some physicians prefer to start w/ this med - but generally agreed should not be first choice
Not FDA approved but ACOG SAYS OK
**Crosses placenta
Previously thought to increase macrosomia and hypoglycemia - now known only to increase hypoglycemia
Contraindicated with sulfa allergy
Usually 2.5-20mg daily in divided doses, up to 30mg/day may be necessary

84
Q

If patient on Insulin or GDM PO meds:
NST ___x/week starting at ___ weeks
and daily ________

A

2x/week @ 32 weeks

daily fetal kick counts

85
Q

this should be initiated at 32 weeks w/ pregestational diabetes, GDM and poor glycemic control or those w/ pharm therapies added to improve glycemic control (ACOG)

A

antenatal fetal surveillance

86
Q

If GDM is diet controlled, no risk for stillbirth, so antenatal testing may not indicated until ____ weeks

87
Q

GDM patients should have growth US @ ____ weeks

A

28-32 weeks

88
Q

IOL:

Diet/exercise controlled GDM - expectant management up to _____ weeks

89
Q

IOL:

Well-controlled medication-dependent GDM- induce at ____ - _____ weeks

A

39 0/7 - 39 6/7

90
Q

symmetric fetal growth restriction occurs in _______ pregnancy

91
Q

assymetric fetal growth typically occurs in _______ pregnancy

92
Q

assymetric fetal growth typically occurs due to:

A

uteroplacental abnormalities (placental function, perfusion)

93
Q

maternal drug use, infections, teratogens cause ____________ fetal growth restriction

94
Q

oligohydramnios in early pregnancy is due to:

A

renal abnormality

95
Q

oligohydramnios in late 3rd trimester pregnancy is due to:

A

placental insuffiency

96
Q 
for \_\_\_\_\_\_\_\_\_\_\_ at 34 weeks:
physician communication
encourage IV/PO hydration
dopper flow studies
fetal surveillance (NST and BPP)
A

oligohydramnios

97
Q

hypERthyroidism is pregnancy is diagnosed by:

A

elevated free T4 levels

98
Q

hypERthyroidism: low _____, elevated _____

A

low TSH, elevated free T4 levels

99
Q

enlarged thyroid on exam without nodules/symptoms/hx of thyroid problems is: _________
What does midwife do?

A

normal; only order TSH if symptomatic

100
Q 
Associated with \_\_\_\_\_\_\_\_\_\_ in pregnancy:
Low birth weight
Preterm birth
Preeclampsia
Fetal growth restriction
Fetal thyrotoxicosis
A

thyroid disorder in pregnancy

101
Q

at 14 weeks, patient reports hair loss and cold intolerance, what should midwife do?

A

order TSH, if abnormal- order further testing

102
Q

What does maternal free T4 do in pregnancy?

A

aids in brain development during entire pregnancy

103
Q

How does thyroid function change during pregnancy?

A

total T3 and T4 increases

TSH decreases

104
Q

trimester in which TSH levels are the lowest

A

1st trimester

105
Q

low TSH but normal free T4 =

A

subclinical hyperthyroidism

106
Q

Treatment for _________ in pregnancy?

Levothyroxine 125 mcg PO daily

A

hypothyroidism

107
Q

Treatment for _________ in pregnancy?
Proplthiouracil (PTU) 200 mg PO TID
Methimazole (MMI) 5 mg PO BID

A

hyperthyroidism

108
Q

After patient starts Levothyroxine for hypothyroidism, the midwife should:

A

Recheck TSH q4-6 weeks

Adjust dose until TSH is within lower limit of normal + 2.5 mu/L

109
Q

Patient presenting with hypERthyroidism symptoms and low TSH, what should midwife do?

A

just order total T3 and T4

110
Q

Check ACOG algorithms for hypo/hyperthyroidism

111
Q 
Associated with \_\_\_\_\_\_\_\_\_ gestation:
PUPPS
Preeclampsia
Preterm birth
Fetal growth restriction- Assymetric
A

multifetal

112
Q

twin-to-twin is common with __________ twins

113
Q

Management of __________:
more frequent prenatal visits
growth US q3-4 weeks
collaborative physician care

A

Twin gestations

114
Q 
Management of \_\_\_\_\_\_\_\_\_\_\_\_:
provide breastfeeding anticipatory guidance
screen for depression
consult mental health resources
consider serial growth US q3-4 weeks
A

opioid dependency

115
Q

IP Management of ___________ patients:

consult anesthesia for epidural placement

A

opioid dependent

116
Q

Women with a history of GDM have a ________-fold increased risk of developing type 2 diabetes compared to women without a history of GDM.

117
Q

ACOG recommends that women with a GDM history have their glycemic status evaluated every __-__ years in addition to providing weight loss and physical activity counseling as needed.

118
Q

polyhydramnios is diagnosed with AFI >/= ____ or DVP of >/= ____

119
Q

Risk Factors for ___________:
Age > 30
Hx SAB / PTB
Family Hx thyroid dysfunction

A

Hypothyroidism

120
Q 
Symptoms of \_\_\_\_\_\_\_\_\_\_\_:
cold intolerance
hair loss
muscle cramps
edema
prolonged relaxation of DTRs
**common to pregnancy:
 fatigue
constipation
weight gain
dry skin
A

Hypothyroidism

121
Q 
Symptoms of \_\_\_\_\_\_\_\_\_\_\_:
Heat intolerance
excessive sweating
tachycardia
palpitations
weight loss
insomnia
A

Hyperthyroidism

122
Q

high levels of hCG can decrease ____ levels to low-range normal

123
Q

TSH levels progressively __________ with advancing gestational age

124
Q

normal TSH level in 1st trimester

125
Q

normal TSH level in 2nd trimester

126
Q

normal TSH level in 3rd trimester

127
Q

if TSH is abnormal, draw _____

128
Q

If TSH level > 2.5, order:

A

TPOAb antibody status

129
Q

High TSH + Low Free T4 =

A

Overt HypOthyroidism

130
Q 
Untreated \_\_\_\_\_\_\_\_\_\_ in Pregnancy Sx:
spontaneous abortions
low birth weight
placenta abruption
preterm birth
preeclampsia
fetal death
A

HypOthyroidism

131
Q

How to take Levothyroxine

A

in the morning on empty stomach and delay eating for 30-60 min after

132
Q

After therapy started for hypothyroidism, check TSH + Free T4 levels q___ weeks

133
Q

Levothyroxine should be adjusted by ___-___ mcg increments until TSH levels are at the lower half of the trimester-specific pregnancy ranges

134
Q

ATA guidelines recommend drawing TSH q___ weeks until midgestation then at least once @ ____ weeks

A

q4 weeks

@ 30 weeks

135
Q

Neuroteratogen:

136
Q

Causes autonomic instability in neonate:

137
Q

Risk Factors for ___________:

A

Oligohydramios

Adv Midwifery Childbearing (4 decks)

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