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Obstetrics > Diabetes in Pregnancy > Flashcards

Diabetes in Pregnancy Flashcards

1
Q

Why does blood glucose need to be carefully monitored in pregnancy?

A

Insulin demand increases

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2
Q

What is the acronym for complications caused by diabetes in pregnancy?

A

SMASH

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3
Q

What is SMASH

A 
S - shoulder dystocia
M - macrosomia
A - amniotic fluid increase (polyhydramnios)
S - stillbirth
H - hypertension/hyperglycaemia
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4
Q

What might uncontrolled diabetes cause in the 1st trimester?

A

Congenital abnormality

Spontaneous abortion

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5
Q

What might uncontrolled diabetes cause in the 2nd trimester?

A

Prematurity risk

Miscarriage risk

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6
Q

What might uncontrolled diabetes cause in the 3rd trimester?

A

Polyhydramnios
Pre-ecclampsia
Still birth
Macrosomia/growth retardation

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7
Q

What is the pathology of macrosomia in diabetes in pregnancy?

A

Glucose crosses placenta and enters foetal circulation

Stimulates release of insulin

Hyperinsulinaemia activates IGF-1

IGF-1 stimulates growth

Remember insulin is the most important growth factor at this stage

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8
Q

What is pre-conceptive management of diabetes?

A

Tight glycaemic control
Folic acid
Avoid vit A
Retinal/renal assessment

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9
Q

What should be done to the insulin dose in diabetes in pregnancy?

A

Increase insulin dose

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10
Q

Pharma management of diabetes in pregnancy?

A

Antidiabetics are okay to use

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11
Q

What is good for use in hypos in pregnancy?

A

Glucagon injections

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12
Q

What must be monitored closely in diabetics who are pregnant?

A

Retinal/renal assessments

Ketone level

Infections!!

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13
Q

What is the labour protocol for diabetics?

A

INDUCE

If macrosomia –> c section

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14
Q

How is blood glucose maintained during labour?

A

Insulin-dextrose infusion

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15
Q

Why does blood glucose need help in labour?

A

CORTISOL RELEASE

Cortisol causes insulin resistance and increased gluconeogenesis

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16
Q

What must be done immediately after birth and why?

A

Encourage early feeding

Risk of hypo from hyperinsulinaemia is high in newborn

17
Q

What is gestational diabetes?

A

Carbohydrate intolerance that begins in pregnancy

18
Q

Which population is at high risk of gestational diabetes (GDM)?

A

Asians

Obese

19
Q

What are other risk factors of developing gestational diabetes?

A

Previous macrosomic baby

Polyhydramnios

20
Q

How is gestational diabetes screened for?

A

HbA1c at 16weeks

21
Q

HbA1c value that requires further testing?

A

43mmol/L

22
Q

What further testing should be done if HbA1c is raised?

A

OGTT

23
Q

When should HbA1c be repeated if normal?

A

24/28 weeks

24
Q

Treatment of gestational diabetes?

A

Insulin

Metformin

Obstetrics (15 decks)

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