NCB II Midterm material Flashcards
average weight gain in PG? fetus lbs? EC fluid lbs? placenta lbs? blood lbs? breast lbs? fat lbs? uterine muscle lbs?
average wt gain: 25-35 lbs fetus: 7-8 lbs EC fluid: 6.6 lbs placenta: 4 lbs blood: 3.3 lbs breast: 3 lbs fat: 3 lbs uterine muscle: 2 lbs
how much does CO increase by? blood volume?
CO increases by 30-40%
blood volume by 35%
how much does O2 consumption increase by? what breathing sx can one experience in PG?
20% increase in O2
may experience SOB
what 3 things increase in relations to the UT?
increased urine production, increased frequency of urination
increased risk of UTIs
what changes with digestion? dt what? (decreased)
decreased HCl, pepsin, gastric emptying and intestinal motility
all are decreased dt progesterone b/c it is a SM relaxor
what hormones increase in PG? what decrease? what body process increases?
increase in: thyroid fxn (decreased TSH, increased T4, same T3), prolactin, cortisol, aldosterone
increased resistance to maternal glucose
hyperlipidemia
decreased GH, FSH, LH
increased metabolism
how much does estrogen increase by? produced by? purpose of it?
estrogen increases by 1000x’s in PG
produced by ovaries and adrenal cortex
E + relaxin increases relaxation of SI jts
influences growth and function of uterus, breasts, labia
stimulates prostaglandin production in 3rd TM
how much does progesterone increase by? produced by? purpose?
increases 10x's in PG produced by corpus luteum and placenta increases blood supply to uterus suppresses maternal immunological response to fetus decreases contractility of uterus
how much does PL increase in PG? produced by? purpose?
increases to 200 mg/mL at term
produced by maternal and fetal pituitary glands and uterus
milk production, increases bonding
prostaglandins are produced by who? purpose?
prostaglandins produced by mother, fetus and placenta
softens cervix and primes maternal body for labor
oxytocin is produced by? purpose?
produced by hypothalamus, released by pituitary
stimulates uterine contractions
milk let-down and ejection
increases bonding
b-hCG is produced by what? purpose?
secreted by early trophoblasts starting at 6th-8th d
provides message to corpus luteum that PG has occurred and prevents degeneration
purpose of HPL?
responsible for insulin resistance and lipolysis
normal placenta anatomy? purpose?
2 arteries, 1 vein
transfers blood from mother to fetus, secretes hormones which maintain PG
how much amniotic fluid is present during PG? flow? functions?
1-1.5 L
flow: fluid replaced every 3hours, metabolizes every 15 hrs
functions: protection, temperature maintenance, allows fetal movement
definition of an embryo? what is going on at this stage?
8 weeks after conception (10 wks PG)
major organ systems are being formed at this time
definition of a fetus?
8 weeks after conception to term
average wt at term? average length at term? during what mos of gestation does most growth occur?
7.0 lbs for females
7.5 lbs for males
20 in average
most growth is b/w 6-8 mos
definition of GD?
glucose intolerance (diabetes) developed during 2nd half of PG, greater than 20 wks gestation
comes on during PG and disappears w/in 6 d of delivery
if develops less than 20 wks gestation considered pre-existing diabetes
GD has no association with increased congenital malformations
average fasting glucose? cut-off for normal? average 1 hr post-prandial glucose? cut-off for normal?
average fasting: 69-75; cut off is less than 95
average 1 hr pc: 105-108; cut-off is less than 120
risk factors for developing GD?
age greater than 30 previous baby greater than 9 lbs maternal HTN maternal obesity FHx of DM excessive maternal wt gain
screening for GD? is HbA1c a good screening test for PG moms?
test random blood glucose at 1st PN if pt is at increased risk: morbid obesity, strong FHx, previous GD, prior macrosomic baby
screen ALL pts at 24-28 wks w/GST
HbA1c is INSENSITIVE at detecting GD
describe the procedure for a GST
when would you recommend a OGTT? when would you recommend checking fasting glucose?
- eat a normal meal
- 2 hours later drink 50 gm glucose drink
- plasma glucose drawn 1 hr later (nothing by mouth except water 1 hr later)
- if GST greater or equal to 130 do OGTT
- if GST greater or equal to 190 do fasting glucose
describe the procedure for an OGTT
at what levels (fasting, 1 hr, 2 hrs, 3 hrs) would you be able to dx GD?
fast overnight (at least 8 hrs)
draw blood
drink 100 gm glucose drink
draw blood again at 1 hr, 2hrs and 3 hrs post drink
at least 2 of the 4 values must be abn to dx GD: fasting greater than 95, 1 hr greater than 180, 2 hrs greater than 155, 3 hrs greater than 140
is a dipstick glucosuria test a good way to monitor or dx GD?
NO
but can be a good screening if not doing a blood draw at that PN
done at every PN
when would you do a random blood glucose test?
to f/u if you have 2 episodes of glucosuria
f/u with a GST if greater than 110 w/in 2 hrs pc or if greater than 101 greater than 2 hrs pc
what can you have a pt w/GD do at home?
home glucometer monitoring so as to monitor their levels
have them measure their blood glucose at 1 or 2 hrs pc (start w/4x/d and decrease)
fasting should be less than 90
1 hr pc should be less than 130
2 hr pc should be less than 120
when do you do biophysical profiles w/a mom w/GD? what other things should the mom be noticing towards the end of PG?
wks 34-36, 38, 40, 41
mom: daily fetal movement counts, close observation for signs of fetal distress
* we need to monitor closely when post-dates or large baby
* standard of care is to deliver at 38 wks
what classification of GD mom’s are eligible for OOH birth? which are not?
Class A1 GD pts w/well controlled blood glucose are safe for OOH births (normal fasting, abn pc glucose)
Class A2 GD are NOT good candidates for OOH birth (abn fasting and pc glucose)
diet recommendations for a mom w/GD? herbs? supplements? lifestyle?
no refined carbs increase fiber increase fruits and veggies herbs: wise woman herbals DM tincture, devil's club root, jambul seed, blueberry lead, dandelion root, bitter melon, gymnema supplements: chromium picolinate lifestyle: exercise 30-60/d
when would you need to check sugar levels during labor?
if mom is on oral meds or insulin need to monitor blood sugar hourly
7 maternal sequelae of GD?
preeclampsia infections pelvic injury (macrosomic baby) C-section dt fetal distress and dystocia cardio-respiratory sxs dt polyhydramnios increased risk of PPH development of T2 DM after PG
4 fetal sequelae of mom w/Class A1 GD?
birth injuries b/c macrosomic
hypoglycemia in neonatal period
hypoxemia in-utero
hyperbilirubinemia
9 fetal sequelae of mom w/Class A2 GD?
birth injuries b/c macrosomic hypoglycemia in neonatal period hypoxemia in-utero hyperbilirubinemia increased perinatal and intra-uterine mortality acidosis dt maternal acidosis hypocalcemia respiratory distress syndrome congenital anomalies
when do you test for MSAFP? what does it stand for? high levels can indicate what? low levels can indicate what?
test for MSAFP at wks 16-18 gestation (must have accurate due dates!)
maternal serum alpha-fetal protein
high levels in: NTDs, underestimation of fetal age, multiple gestation, threatened abortion, fetal demise
low levels in: Down syndrome, overestimation of fetal age, fetal demise, hydatidiform mole
if MSAFP is high or low, what is your f/u?
f/u with U/S and possibly amniocentesis
3 abn lab findings in Down’s?
low MSAFP, low uE3, high hCG
