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Year2 Repro exam II > Wed- DM in pregnancy and ectopics > Flashcards

Wed- DM in pregnancy and ectopics Flashcards

1
Q

What is class B DM

A

onset at age 20 or older with duration less than 10 yrs

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2
Q

what is class C DM

A

onset age 10-19 duration 10-19 years

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3
Q

what is class D DM

A

onset before age 10 duration >20 yrs

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4
Q

what is class E DM

A

over DM with calcified pelvic vessels

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5
Q

what is class F DM

A

diabetic nephropathy

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6
Q

class R DM

A

proliferative retinopathy

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7
Q

class RF DM

A

retinopathy and nephropathy

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8
Q

class H DM

A

ischemic heart disease

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9
Q

class T DM

A

prior kidney transplant

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10
Q

what is DM I

A

destruction of beta cells o pancreas

absolute insulin deficiency

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11
Q

what is DM II

A

insulin R and relative insulin deficiency

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12
Q

how to manage DM II

A

lifestyle modification, diet, exercise, pharm

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13
Q

what is gestational DM

A

any degree of glucose intolerance with onset or first recognition during pregnancy

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14
Q

what causes gestational DM

A

condition in which a hormone made by placenta prevents body from using insulin effectively

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15
Q

what is risk of DM after GDM

A

50-70%

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16
Q

what happens to excess glucose in GDM

A

stored as fat in the fetus

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17
Q

risk factors GDM

A 
increasing maternal age and weight
previous GDM
previous macrosomic infant
FMH DM
ethnic background with increased DM
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18
Q

what occurs to metabolism in first trimester

A

fasting blood glucose decreases from insulin production and sensitivity increases

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19
Q

what occurs to metabolism after first trimester

A

insulin sensitivity decreases

increase in insulin production

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20
Q

how is euglycemia maintained in pregnancy

A

beta cells produce enough insulin to counteract increasing resistance

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21
Q

complications GDM

A 
HTN
preeclampsia
SAB
worsening of DM complicaitons
fetal growth restriction with vasculopathy
ketoacidosis or severe hypoglycemia
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22
Q

complications of GDM for baby

A 
macrosomia
hypoglycemia at birth
hyperbilirubinemia
low ca and Mg
RDS
polycythemia
hyperviscosity
increased risk for childhood and adult obesity
increased risk DM II later in life
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23
Q

risks of preterm birth

A 
GDM
uncontrolled preexisting DM
vascular disease
HTN disorders
obesity
24
Q

what are the tests to order for GDM

A

50 g glucose challenge test

oral glucose tolerance test, 75 or 100g

25
Q

what glucose levels are Dx for GDM

A

fasting plasma glucose of 126

random plasma glucose of 200

26
Q

indications for delivery in GDM

A 
poorly controlled blood glucose
abnormal fetal testing
fetal growth restriction
deterioration of vascular complications
significant macrosomnia
27
Q

indications for increased surveillance uring labor

A 
macrosomia
growth restriction
abnormal level of amniotic fluid
uncontrolled blood glucose
elevated A1C
frequent hospital admissions during pregnancy
little or no prenatal care
28
Q

what to do in a woman with DM with anticipated labor 6-8 hours

A

IV dextrose administered hourly at a rate of 100ml to 150ml

29
Q

what level of blood glucose in maintained during labor to reduce risk of maternal and fetal hyperglycemia

A

<110

30
Q

what patients must have insulin during labor

A

DM I

31
Q

immediatley postpartum what occurs to metabolism

A

insulin resistance dramatically improves

32
Q

what therapy is used when mother is breastfeeding

A

oral anti-DM medications

33
Q

pregestational DM are at increased for what when they breast feed

A

episodes of hypoglycemia

34
Q

Tx for pregestational DM woman who is breast feeding

A

eat a 15 g carb snack before or during breastfeeding

35
Q

Tx for GDM

A 
special diet
exercise
daily blood glucose monitoring
insulin injections
pharm management
36
Q

what must you check before advise patient with GDM to use exercise as a Tx method

A

vascular complications

37
Q

when can a patient with GDM exercise

A

if blood sugar >250 and negative ketones

38
Q

when should a patient with GDM definitely not exercise

A

bloos sugar level>250 and ketones +

39
Q

tests to order for 23 y.o complaining of intermittent bleeding and LMP

A 
pregnancy
UA
pap
cultures
CBC
platelet count +
US +
40
Q

in a normal pregnancy what does hCG do

A

double every 48 hours

41
Q

if abnormal pregnancy what does hCG do

A

hCG can stay the same, decrease or increase minimally

42
Q

risks associated with 1st trimester bleeding

A

miscarriage
abnormal placenta implantation
IUGR

43
Q

an abnormal pregnancy can be what

A

missed abortion
complete abortion
incomplete abortion
molar pregnancy

44
Q

risk factors for spontaneous abortions

A 
maternal age (older the higher)
previous spont abortion
prolonged time to implantation interval
prolonged time to conception
smoking
EtOH
cocaine
NSAIDs
caffeine
low folate levels
extremes of maternal weight
fever during early pregnancy
unrecognized celiac disease
45
Q

what are fetal causes of spontaneous abortions

A

chromosomal abnormalities
congenital abnormalities
trauma

46
Q

what are maternal causes of spontaneous abortions

A

uterine structural issues
acute maternal infections
maternal endocrinopathies
hypercoagulable states

47
Q

Sx for spontaneous abortions

A

vaginal bleeding
pelvic pain
absence of fetal movement
incidental finding on US/ hand-held Doppler

48
Q

labs to order for spontaneous abortion

A 
hand held doppler
pelvic exam
pelvic US
hCG
blood type Ab screen
serum progesterone
49
Q

what is criteria for spont abortion on pelvic US

A

gestational sac >25 mm without yolk sac or embryo

embryo with crown rump length that does not have cardiac activity

50
Q

Tx for threatened abortion

A

bed rest and expectant management

51
Q

50% threatnened abortions will have wha toutcome

A

miscarriage

52
Q

Tx options for inevitable abortion

A

medical
surgical
expectant management

53
Q

Tx options incomplete abortion

A 
medical abortion (misoprostol)
surgical abortion (D&C)
expectant management of infections
54
Q

Tx completed abortion

A

examination of passed tissue to confirm products of conception
transvaginal US to see empty uterus
follow hCG levels until zero

55
Q

risk factors ectopic pregnancy

A 
previous ectopic
PID
assisted repro technology
history peritonitis
smoking
previous tubal ligation
56
Q

Tx ectopic pregnancy

A

MTX- folic acid inhibitor
surgical- removal of ectopic
removal of tube

Year2 Repro exam II (19 decks)

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