Complicated Pregnancy 4 Flashcards

1
Q

This Deck will cover Diabetes

A

Pre-existing Type 1 or 2 DM

Gestational (GDM)

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2
Q

There are 2 mechanisms by which pre-existing diabetes causes a problem

A
  • Raised insulin requirments of the mum
  • Hyper-insulinaemia of the foetus
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3
Q

What causes insulin requirements to rise during pregnancy?

A

Production of certain anti-insulin hormones:
- Human Placental Lactogen
- Progesterone
- HCG
- Cortisol

This causes problems for mum if insulin doses aren’t adjusted well enough

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4
Q

By what mechanism do you get foetal hyper-insulinaemia in pre-existing diabetics?

A

High maternal glucose crosses placenta to bairn
–> Increase in foetal insulin production
–> Problems
E.g. Macrosomia, neonatal hypoglycaemia & respiratory immaturity

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5
Q

What risks does pre-existing DM hold for the mother?

A
  • Miscarriage
  • Pre-eclampsia
  • Worsening of diabetic complciations e.g. nephropathy, retinopathy or hypos
  • Infections
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6
Q

What risks foes pre-existing DM hold for the baby?

A
  • Macrosomia & Shoulder Dystocia
  • Polyhydramnios
  • Stillbirth
  • Neonatal Hypoglycaemia and resp distress
  • Prematurity
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7
Q

Its useful to split obstetric management of pre-existing DM into 3 “phases”

A
  • Pre-conception
  • Pregnancy
  • Labour
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8
Q

What actions should we take prior to a diabetic actually getting pregnant?

A
  • Optimise the Glycaemic control till its in 4-7mmol/l
  • Give folic acid
  • Give Dietary Advice
  • Do Retinal & Renal Assessments
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9
Q

What medications can we provide diabetics during pregnancy?

A
  • Insulin (increased dose or replacing oral drugs) to optimise control
  • Conc glucose solution or glucagon injections in case of hypos
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10
Q

What should we monitor in a pregnant diabetic during the actual pregnancy phase?

A
  • Blood glucose
  • BP & urine protein (Pre-eclampsia)
  • Look out for Ketonuria & Infections
  • Foetal Growth
  • Retinal Assessment at 28 & 34 wks
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11
Q

Do diabetic women deliver by normal delivery?

A

Most are induced around 38-40wks due to macrosomia

You should always consider C-section if the baby is large to avoid complications such as shoulder dystocia or tears

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12
Q

What else should we do during and after labour to ensure a diabetics mothers (and foetuses) health?

A
  • Use insulin during labour to maintain the sugar level
  • Continuous CTG

Feed the baby early to avoid hypos

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13
Q

What is Gestational DM?

A

Carb intolerance in pregnancy and abnormal glucose tolerance reverting to normal after delivery

Its risky but not nearly as dangerous as Type 1 or 2 DM

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14
Q

What are the risk factors for developing gestational DM?

A

Any H/o GDM or FH of DM

A previous macrosomic baby

Polyhydramnios, large foetus or recurrent glycosuria in the current pregnancy

Increased BMI >30

Coming from a high risk group for DM e.g. Asian origin

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15
Q

Who do we screen for GDM?

A

Any women with risk factors

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16
Q

How do we screen for GDM?

A

1) Risk factors?
–> 2) HbA1C. >43mmol/mol (6%)
–> 3) OGTT

If OGTT is Abnormal then you can diagnose with GDM

If OGTT is normal repeat it again at 24 wks

17
Q

How do we manage a mother with GDM?

A

Sugar control!:
- Start with Diet
- Insulin & Metformin

18
Q

How is GDM managed after the delivery?

A

Glucose should return to normal, check with OGTT 6-8wks PN

Yrly HbA1C due to the high risk of developing overt DM now