Labor & Delivery - Concurrent Disorders During Pregnancy - Unit 2 (Class)

Question 1

What are the classic symptoms of diabetes?

Answer 1

Polydipsia, polyuria, polyphagia

Question 2

Early pregnancy DM - causes?

Answer 2

Small change in maternal metabolic need, insulin release in response to serum glucose levels… hypoglycemia can happen.

Question 3

Late pregnancy - DM?

Answer 3

Fetal growth accelerates, rise in placental hormone levels, hormones create resistance to insulin.

Question 4

Birth - DM info

Answer 4

Maintenance of normal maternal glucose levels is essential during birth to reduce neonatal hypoglycemia.

Question 5

Insulin acts like a growth hormone for bambinos, so that’s why diabetes babies can be so ___.

Answer 5

Big

Question 6

What is GDM?

Answer 6

Gestational Diabetes Mellitus

Question 7

Diabetes Mellitus - preeclampsia is __ to __ times more likely to develop, along with ___ and spontaneous ___.

Answer 7

2-3 times.

preeclampsia and spontaneous abortion.

Question 8

What are some neonatal effects of DM?

Answer 8

Hypoglycemia, hypocalcemia, hyperbilirubinemia, respiratory distress syndrome.

Question 9

DM - can they do oral agents?

Answer 9

Nope, mainly insulin.

Question 10

What are parts of the physical exam for DM? Lab tests?

Answer 10

ECG, opthalmology referral, height/weight/BP

24 hr urine and AIC

Question 11

DM - fetal assessment - what? when?

Answer 11

Surveillance should be begin EARLY - testing for anomalies, ultrasounding frequently, fetal kick count, echo (make sure babies heart is okay)

Question 12

How do we manage DM?

Answer 12

Maintain normal BG levels, avoid accelerated impairment of blood vessels and other major organs, preconception care, diet, self-monitoring of glucose, insulin therapy, etc.

Question 13

What are some risk factors for gestational diabetes mellitus?

Answer 13

Overweight, maternal age greater than 25 years old, previous birth outcome often associated with GDM, previous GDM, family history of diabetes, abnormal glucose tolerance, member of a high-risk ethnic group, etc.

Question 14

How do we screen for GDM?

Answer 14

1 hour test (50 g of oral glucose shit),

If abnormal, 3 hour glucose test (OGTT) with 100 g of the shit.

Question 15

Oral glucose challenge test - numbers for fasting, 1 hr, 2 hours, 3 hours.

Answer 15

fasting = greater then 95
1 hour = greater than 180
2 hours = greater then 155
3 hours = greater than 140

Question 16

How do we manage GDM?

Answer 16

diet (dietician, educator, etc), nonobese prepregnancy weight - 30 kcal/kg/day is recommended - obeses = 25kcal/day, exercise, blood glucose monitoring, fetal surveillance

Question 17

Cardiac disease - heart disease complicates about 1% of pregnancies. T/F?

Answer 17

True

Question 18

What are the two major categories of heart disease?

Answer 18

Rheumatic and congenital

Question 19

Rheumatic heart disease - what can cause it? Common site? May lead to???

Answer 19

Streptococcal pharyngitis can cause it.

RHD may cause scarring of the heart vessels - typically mitral valve.

May lead to pulmonary hypertension, pulmonary edema, or congestive heart failure.

Question 20

Congenital heart disease - left to right shunt. What is it?

Answer 20

Arterial septal defect, ventricular septal defect, patent ductus arteriosus

Question 21

congenital heart disease - right to left shunt - what is it?

Answer 21

Tetralogy of fallot (4 rare defects), eisenmenger’s syndrome (untreated cardiac stuff)

Question 22

With heart stuff for mom, what is our focus?

Answer 22

Keeping her safe and finding the farthest point we can go to - like “can she safely make it to 32 weeks? 34 weeks? etc.”

Question 23

“You have a patient with rheumatic heart disease, which symptom would you be worried about?”

Answer 23

Rales!!!!

Question 24

what are some symptoms of heart disease?

Answer 24

dyspnea, syncope, hemoptysis, paroxysmal nocturnal dyspnea, chest pain with exertion, additional signs, etc.

Question 25

300-500 ml of blood is shifted from the uterus and placenta into the central circulation. T/F?

Answer 25

True

Question 26

Vaginal delivery - NOT recommend for a woman with heart disease. T/F?

Answer 26

FALSE - it is (unless otherwise indicated)

Question 27

Workload of heart increases AFTER birth because of the blood that is going back to mom. T/F?

Answer 27

True

Question 28

Watch for signs of CHF in postpartum - T/F?

Answer 28

True (includes cough, progressive dyspnea, orthopnea, heart palpitations, progressive fatigue/syncope, rales, etc.

Question 29

Thalassemia - what is it?

Answer 29

Vitamin B deficiency

Question 30

Treat anemia’s as they present - T/F?

Answer 30

True - like iron deficiency? given iron.

Question 31

Do things like systemic lupus erythematosus, antiphospholipid syndrome, hashimoto’s thyroiditis, rheumatoid arthritis, seizures, bell’s palsy…get better or worse with pregnancy?

Answer 31

Sometimes better!

but with seizures, they can still occur, so watch for risk of falling!

Question 32

Cytomegalovirus - where does it come from?

Answer 32

Cat litter box - so get the automatic one.

Question 33

Rubella - can they get the MMR vaccine?

Answer 33

Not while pregnant- it’s a live virus. So no pregnancy for 3-6 months after, as well.

Question 34

Varicella zoster virus - what is it?

Answer 34

Chicken pox…..don’t want it during pregnancy, can cause major issues. get the vaccine!

Question 35

HIV - worried about baby?

Answer 35

Yes….antiviral meds are important. But still can be breastfed, just check viral load!

Question 36

toxoplasmosis - common during pregnancy?

Answer 36

yes

Question 37

TB moms - can get pregnant?

Answer 37

Yes…just use normal precautions you would for TB!