Week 7 Flashcards
Formal definition of Gestational Diabetic
GCM characterized as carb intolerance that begins or is first noticied in pregnancy.
glucose metablism in pregnancy is considered a ________ _______
diabetogenic state
Does insulin cross the placenta?
no
Why is GD not usually an issue in the first half of pregnancy?
Bc estorgen and progesterone casues a decrease in maternal glucose levels
How does estorgen and progesterone decrease maternal glucose levels?
the cause hyperplasia of pancreatic beta cells which increases maternal insulin levels.
In the second half of pregnancy you have insulin _______
resistance
In the second half of pregnancy you have increased hepatic production of ____
glucagon
INsulin requirements may ____ in second half of pregnancy
triple
_______ is responsible for two insulin degrading enzymes
placenta
what is somogyi response?
hypoglycemic response at night with rebound hyperglycemia
what is dawn phenomenon?
increase in nighttime hypergycemia
when is ist appropriate to do first trimester screening for GD?
GDM in previous pregnancy, macrosomic infant in previous pregnancy, maternal obesity, hx of stillbirth
acceptable range for 1 hr GTT
<140
rule of thumb for 3 hr GTT
- in the am after an overnight fast
- no smoking before the test
- follow unrestricted diet consuming at least 150g carb/day for three days
fetal survaillence with GD at 16-20 weeks
genetic testing, amnio, level II US
fetal surveillence with GD at 20-22 weeks
level II or serial U/S
fetal surveillence with GD at 28-32 weeks
kick counts, weekly NST, serial US
fetal lung maturaty test in GD to be doe routinly at
37-40 weeks
What will the amnio show if fetal lung maturaty is established?
PG preset and LS ration 2
When should a person with GD have postpartum GTT?
6-8wks
What is the leading global cuase of maternal and infant illness and death?
preeclampsia
definition of gestational hypertension
HTn ONLY in pregnancy
definition of preeclampsia
HTN state prior to eclampsia
definition of superimposed preeclampsia
high readiness of preeclampsia on top of chronic HTN
definition of chronic HTN
HTN either before pregnancy or dx before 20 weeks gestation and presistant after 12 weeks postpartum
HTN is diagnosed by waht reading?
140/90
What is NOT criteria for hypertensive disorder?
edema
Criteria for gestational hypertension
- detected for the first time after mid pregnancy
- NO protenuria
- Bp returns to normal after 12 weeks pp
- May have other s/s such as thrombocytopenia na depigastric discomfort
Criteria for preeclampsia
- minimum BP 140/90 after 20 weeks
- proteniuria >300mg/24 hours or greater >1+ dipstick
- increased LDH
- elevated ALT and AST
- persistant epigastric pain from swollen liver
What does HELLP syndrome stand for?
Hemolysis, elevated liver enzymes, low platalets.
What are the renal effects of preeclampsia?
- decreased GFR
- decreased clearance of protein, uric acid, and sodium
If diastolic is <100 and +1 protein…what condition?
mild preeclampsia
With preeclampsia serum creatianine and uric acid are _______
elevated
vulvar mass at 5 or 7 o clock is what?
bartholins gland cyst or abscess
what is the course of action with a positive RPR?
requires confirmation with treponemal test (MHATP or FTA-ABS)
When hcg levels above threshold and no IUP seen on transvag US, most likely _____
ectopic
hcg should double every _____hours
48
If a pt is hpyotensive or has severe adenexal pain…what is happening?
they are most likely bleeding internally from ruptured ectopic and require surgery immediatly
open cervical os, cramping, hx of passing tissue =
incomplete ab
closed cerival os, completion of bleeding and cramping follwing passage of tissue, with small firm uterus =
complete ab
what is the most common cause of first trimester miscarriage?
fetal karyotype abnormality
How do you treat an incompetant cervix with painless cervical dilation?
cerclage
painless antepartum bleeding =
placenta previa
painful antepartum bleeding =
abruption
major risk factors for placental abruption are (3)
HTN, cocaine, trauma
what is the most common cause of antepartum bleeding with coagulopathies?
abruption
What is the KB test for?
used to measure the amt of fetal hgb trasnferred to mothers blood stream- usually done in rh negative moms
What is the most common cause of generalized pruritis in pregnancy in the absence of actual lesions?
cholestatsis
Where are the lesions of PUPPS usually noted?
abd spreading to thighs and buttocks and arms
you cant see a PE on ______
chest xray
what is the most common symptom of PE?
dyspnea
PE is confirmed with a ______
CT scan
What is the best tx of DVT or PE?
anticoagulation therapy
______ is NOT diagnostic of preeclampsia
edema ( both dependent or non dependent)
When is chronic HTN diagnosed?
When the pt has HTN prior to 20 weeks gestation or past 12 weeks pp
How will an ovarian torsion present?
acute onset of colicky abd pain
How with someone with an appendicitis present?
n/v, fever, anorexia, increased WBC, positive mcverneys (right lower abd)
How so you determine between ectopic and corpus luteum cyst from products of conception?
ectopic will float in normal saline
low TSH
hyperthyroidism (graves)
high TSH
hypothyroidism (hashimotos)
how does pregnancy effect thyroid hormones normally?
- total thyroxine and thyroid binding globulin increase
- free t4 and TSH unchanged
prime culprits for fifths diseae (parvo)
school teachers
what can parvo (fifths disease) cause for baby’s
fetal anemia and fetal hydrops
what is one of the earliest signs of fetal hydrops?
hydramnios
children with parvo (fifths disease) usually present with….
high fever, lacy rash, “slapped cheeks”
**Adults typically dont have the fever or red cheeks
Which trimester is parvo particularlly bad?
second and third
If you have had _____ you are immune and will never get it again
Parvo (fifths disease)
elevated afp suggests
NTD
What will the enzymes do in a triple screening that is positive for downs?
- high hcg
- low afp and estriol
when is a nucal cord translucency test performed?
11-14 weeks
what does the quad screen add to the triple screen?
inhibin a
After a completed abortion is determined, what is the next step?
- weekly hcg levels to ensure that they decrease to <5 (usually takes 2-3 weeks).
- blood typing
- maybe hgb
How is a molar pregnancy characterized?
- spotting
- EXTREMELY high hcg
- no FHT
- uterus larger then dates
how ia a molar preg dx?
us
If a woman has been exposed to fifths disease (parvo) what is the first step in treatment?
test for immunity: igg and igm
Why does getal hydrops occur?
because of fetal anemia.
Parvo virus inhibits __________
bone marrow erythrocyte production
How will parvo present in an adult?
myalgia, malaise, mild rash
What is the first step when a pt complains of calf pain?
doppler sonography
When is bedrest appropriate?
never
What are the normal value for one hour GTT (acog and ada)
ACOG 130
ADA 140
When is rhogam given
28 weeks
How long is rhogam good for?
12 weeks
when is macrobid contraindicated?
after 36 weeks bc it has been linked with fetal jaundice
which antibodies cause problems in pregnancy?
kell kills
Which trimester is rubella the most harmful?
first
Which trimester is fifths disease the most harmful?
second
which trimester is varicella the most harmful?
third
which trimester is CMV the most dangerous?
especially in first
what test do you perfomr to see how much rhogam to administer?
KB
