Pregnancy Complications - Wootton Flashcards
Risk factors for GDM
Obesity, previous history, strong family history, known glucose intolerance
Complications (mom) of GDM
- HTN
- Preeclampsia
- C-section
- DM later
Complications (fetus) of GDM
- Macrosomia
- Hypoglycemia @ birth
- Hyperbilirubinemia
- Operative delivery
- Shoulder dystocia
- Birth trauma
Pre-gestational DM is most crucial in what time period?
Embryogenesis - birth defects (6x increase)
How to screen for GDM?
When do you screen? Why?
Negative value (1 hr)?
Glucose tolerance test
26-28 weeks (hPL is at highest, will make you glucose intolerant if it’s gonna happen at all)
Less than 135
When are you diagnosed w/ GDM?
Treatment?
2+ abnormal GTT values (1 hr + 3 hr tests)
Diet counseling, oral hypoglycemic meds (glyburide), insulin
Normal blood glucose fasting level (w/ treatment)
Normal post-prandial (2 hr) glucose level (w/ treatment)
Less than 90
Less than 120
Maternal complications of GDM?
Main fetal complication? Requires what? Risk for what?
Other important complications?
DM later, birth trauma, HTN, preeclampsia
Macrosomia (large abdomen)
- C-section
- Risk for shoulder dystocia (can’t get belly out at birth)
Intrauterine death, hyperbilirubinemia, operative delivery, birth trauma
A baby greater than ____ must be delivered via C-section
4500 grams
32 G2P1 at 14 weeks, has had DM for 7 years, takes Metformin and Glyburide. High HbA1c
Maternal complications? (3)
Baby defects? (4)
- Worsening retinopathy or nephropathy
- Preeclampsia
- DKA
- ***Fetal cardiac defects
- Spontaneous aboriton
- Growth restrictions
- Prematurity
Studies to evaluate maternal health in DM pregnancy? (5)
- Kidney function
- EKG (vascular dz)
- Ophthalmology
- Thyroid studies
- Glycemic control
Studies to evaluate fetal health in DM pregnancy? (5)
- Ultrasound for dating, etc
- Biochemical testing/nuchal translucency
- Detailed ultrasound for fetal anatomy (EKG, etc.)
- Growth ultrasounds
- Antenatal testing
How to deliver DM pregnancy? When?
Vaginal - try to get to wk 39 (lungs mature slower than normal)
25 G3P1 at 30 weeks, has fever and tachycardia. Diaphoretic. Overactive thyroid and can’t remember what drugs she takes…
Dx?
Thyroid storm
- Beta blockers
- IV fluids
- Antipyretics
- PTU/Methimazole
Fetal effects w/ hyperthyroidism
- Fetal goiter (can’t deliver)
- Fetal hypothyroidism