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MRCOG - Part 2 > Diabetes Mellitus > Flashcards

Diabetes Mellitus Flashcards

1
Q

Percentage of diabetic cases in pregnancy

A

2-5%

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2
Q

Percentage of diabetes by types in pregnancy

A

GDM 87.5%
Type1 7.5%
Type2 5%

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3
Q

Diabetes in pregnancy is associated with risks to the woman and to the fetus which are

A

Pregnancy:
- Miscarriage
- still birth
- preterm labor
Mother:
birth injury,
prenatal mortality,
postnatal adaptation problems,
preeclampsia
diabetic retinopathy
Fetus:
congenital malformations,
macrosomia

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4
Q

The preferable contraceptive method of a women with DM

A

Oral contraception

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5
Q

Dietary supplements of women with DM planning for pregnancy

A
  • Women with BMI>27: lose weight
  • Folic acid 5mg/day until 12 weeks
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6
Q

Target ranges for blood glucose in the preconception Period.

A

*HbA1c level below 48mmol/mol (6.5%)
Strongly against pregnancy if HBA1c level is above 86 mmol/mol

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7
Q

Safest diabetes mellitus drug during pregnancy

A
  • Metformin is used instead of Insulin
  • The short acting insulin analogues (aspart, lispro)
  • Isophane Insulin is 1st choice long acting insulin analogues (insufficient evidence)
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8
Q

What diabetic complications medications are CI during pregnancy

A

ACEI, ARB AND STATINS

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9
Q

Retinal assessment in the preconceptional period in diabetic patient

A

At the first appointment, then annually

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10
Q

When to refer to nephrologist in diabetic patient

A
  • S creatinine is abnormal (120 µmol/L or more) or
  • Urinary albumin:creatinine ratio is greater than 30 mg/mmol or
  • Estimated GFR is less than 45 mL/minute/ 1.73 m²
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11
Q

Risk factors for GDM

A

1- BMI>30kg/m2
2- previous macrosomic baby >4.5 kg
3- Previous GDM
4- Family History for DM
5- FAMILY origin with high prevelance

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12
Q

Screening if any of the 5 risk factors for gestational diabetes

A

2-hour post prandial 75g OGTT
At 24 to 28 weeks

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13
Q

Screening for GDM exclusion if there is glycosuria

A

2+ or more at 1 occasion
Or
1+ or more at 2 occasions

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14
Q

Screening for GDM in case of previous GDM

A
  • early self monitoring of blood glucose
    Or
  • 75g 2-hour OGTT at booking, if normal then repeat at 24-28 w
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15
Q

Diagnosis of GDM

A

Fasting: >5.6 mmol/L
Or
2hours: >7.8 mmol/L

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16
Q

Intervention if fasting plasma glucose level below 7mmol/L

A
  1. Trial to diet and exercise
    (If it doesn’t reach target level in 1-2 w)
  2. Metformin
    (If contraindicated or unacceptable)
  3. Insulin
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17
Q

Intervention if fasting plasma glucose level above 7mmol/L

A

Immediate ttt w/ insulin

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18
Q

Management of DM during pregnancy

A
  1. Diet and exercise or
  2. Oral therapy
  3. Rapid acting insulin analogues (aspart- lispro) better than human insulin during pregnancy
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19
Q

If woman w/ type 1 become unwell:

A

Exclude DKA

IF DKA confirmed:
1. Level 2 critical care
2. Daily fasting and 1 hour

20
Q

Maintain GDM patient capillary plasma glucose

A

Fasting: <5.3 mmol/L
1 hour post prandial: <7.8 mmol/L Or
2 hour post prandial: <6.4 mmol/L

If on Insulin or glibenclamide: >4 mmol/L

21
Q

Retinal assessment during pregnancy

A

If w/ prexisting DM-> Retinal assessment at booking:
1. If normal: repeat at 28 w
2. If retinopathy: 16-20 w

22
Q

Mode of birth in case of Diabetic retinopathy

A

It isn’t a contraindication to vaginal birth

23
Q

In DM pregnant woman, when to perform congenital malformations screening

A

18-20 weeks

Examination of the 4 chambers and outflow tracts

24
Q

Monitring Fetal Growth and wellbeing in DM

A
  • U/S scan for fetal structural abnormalities
  • Fetal Heart~4 chambers , outflow tracts & 3 vessels (20 W)
  • USG- FG & AF volume - every 4 weeks for 28 to 36 weeks
  • If Risk of FGR - Umbilical a. doppler & fetal weelbeing b/f 38 W
25
Q

Tocolysis in DM

A

Diabetes isn’t a CI of antenatal stroids or tocolysis
(Betamemitics is CI)

26
Q

diabetic women who recieve antantal steroid for lung maturation

A

should have additional insulin and should be closely montiored

26
Q

Protocol of diabetic women who recieve antantal steroid for lung maturation

A

should have additional insulin and should be closely montiored

27
Q

Care of diabetic women in booking appointment (10 W)

A
  1. Educate about diabetes
  2. Retinal assesment (if she didn’t have it in last 3 months.
  3. Measure HbA1c (if preexisting DM)
  4. Self monitoring of blood glucose or a 75 g 2-hour OGTT if has hx of GDM
  5. Check viability and Gestational Age at 7-9 W
28
Q

Care of diabetic women at 16 W

A
  1. Retinal assesment (if she has confirmed retinopathy at booking)
  2. Self monitoring of blood glucose or a 75 g 2-hour OGTT if has hx of GDM
29
Q

Care of diabetic women at 20 W

A

U/S scan of fetal structural abnormalities

30
Q

Care of diabetic women at 28 W

A
  • U/S - FG & AFV
  • Retinal Assesment to all women w/ pre-existing DM
31
Q

Care of diabetic women at 32 W

A
  • U/S - GF & AFV
  • Naulliparous: routine investigations (31 W)
32
Q

Care of diabetic women at 36 W

A
  • U/S - FG & AFV
    - Information about:
  • timing , mode of birth
  • anlagesia & anasthesia
  • Breast Feeding
  • Contraception
33
Q

Care of diabetic women at 37 to 38+6 w

A
  • Await for Spontaneous labour
  • IF type 1 or 2: offer IOL or CS if indicated
34
Q

Care of diabetic women at 38 W

A

Test for fetal wellbeing

35
Q

Care of diabetic women at 39 W

A
  • Tests for fetal wellbeing
  • Advise women w/ uncomplicated GDM to give birth before 40+6
36
Q

Mode and timing of delivery in type 1 or 2 DM

A
  • IOL, elective CS bet. 37 to 38+6
  • Elective birth bef. 37w (if complications)
37
Q

Mode and timing of delivery in GDM

A
  • IOL, elective CS no later than 40+6
  • elective <40+6 if not delivered by 40+6 or complications
38
Q

VBAC with Diabetic women?

A

Not contraindicted

39
Q

What to do if you used general anasthesia on Diabetic woman

A

Blood glucose should be monitored every 30 mins. from induction till birth.. woman should be conscious

40
Q

Glycemic control during labour

A
  • Glucose should be 4-7 mmol/L
  • if not: start IV dextrose & Insulin infusion
  • Type 1: IV dextrose & Insulin infusion from onset of labour.
41
Q

Fasting plasma glucose test after birth should be done at?

A

6-13 weeks after birth

42
Q

Fasting plasma glucose test after birth below 6 mmol/L
or
HbA1c test below 39mmol/L (5.7%)

A
  • low probability of having diabetes at present
  • have moderate risk of developing type 2
43
Q

Fasting plasma glucose test after birth bet. 6- 6.9 mmol/L
or
HbA1c test below 39-47mmol/L (5.7-6.4%)

A

High risk of developing type 2 diabetes

44
Q

Fasting plasma glucose test after birth over 7 mmol/L
or
HbA1c test 48 mmol/L (6.5%)

A
  • Likely to ahve type 2 diabetes
  • Offer diagnostic test for confirmation
45
Q

If ater birth fasting plasma glucose or HbA1c is negative

A

Annual HbA1c test

MRCOG - Part 2 (30 decks)

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