Pregnancy Complications Flashcards
How GDM is screened?
1-hr (50g) oral glucose tolerance test (OGTT)
- If Negative (<130-140 mg/dL) → Routine prenatal care
- If Positive (≥ 130-140 mg/dL) → 3-hr (100 g) OGTT
How is GDM diagnosed?
3-hr (100 g) OGTT
- Negative
- Positive for GDM
- Two or more values are met or exceeded:
- Fasting – 95 mg/dL
- 1-hr – 180 mg/dL
- 2-hr – 155 mg/dL
- 3-hr – 140 mg/dL
- Two or more values are met or exceeded:
What is the Non-stress test?
- Non-invasive, patient goes to provider’s office, often biweekly)
- External fetal monitor placed on abdomen, expect to see two 15x15 accelerations in 20 minutes if greater than 32 weeks EGA; predictive of fetal well-being for 3-4 days
What does a reactive non-stress test indicate?
A reactive non-stress test result indicates that the fetus’s heart rate increased normally in response to movement or contractions.
What does a non-reactive non-stress test indicate?
A non-reactive result means the heart rate didn’t increase enough.
What is a Biophysical profile (BPP)?
- evaluates the well-being of a fetus, particularly in high-risk pregnancies
- non-invasive
What are the five components assessed during a Biophysical profile?
Scored from 0-10, with lower score being more indicative of issues/need to deliver:
Fetal breathing
Fetal tone (extension/flexion of limb, opening/closing fist)
Fetal movement
AFI (amniotic fluid index)
Reactive non-stress test
What is the etiology of gestational diabetes (GDM)?
- Glucose crosses placenta, insulin does not
- Placental hormones increase
insulin resistance - insulin requirements increase between 26-34 weeks gestation
What is GDM associated with?
- Polyhydramnios
- Increased rate of fetal death
- Macrosomic infant (>4000gms)
- Prematurity, RDS, hypoglycemia, polycythemia in the newborn
- Congenital heart defects
How is GDM managed?
- Universal screening between 24-28 weeks
- Early screening if pt has risk factors:
- history of GDM with prior pregnancy
- strong family history of diabetes
-obese
How is chronic hypertension characterized in pregnancy?
- The presence of hypertension prior to pregnancy
- Diagnosis of development of hypertension before 20 weeks
How is GDM managed?
- Universal screening between 24-28 weeks
- Early screening if pt has risk factors:
- history of GDM with prior pregnancy
- strong family history of diabetes
- obese
How is gestational hypertension characterized in pregnancy?
- Development of hypertension after 20 weeks gestation
- Absent criteria for preeclampsia
What is the diagnostic criteria for gestational hypertension?
- SBP ≥ 140 or DBP ≥ 90, or both measured on 2 different occasions at least 4 hours apart after 20 weeks gestation
How is preeclampsia characterized in pregnancy?
- New onset hypertension which occurs most often after 20 weeks
- Often accompanied by new onset of
proteinuria
