Dunn OB/GYN V

Question 1

society getting bigger

Answer 1

more risks for diabetes

Question 2

american indian

Answer 2

higher risk of diabetes

Question 3

pre-screening in obese pregnant women

Answer 3

prenatal labs
group B strep
ultrasound
HgA1c

Question 4

> 4000g baby

Answer 4

LGA - large for gestational age

consider delivery if 37 weeks

Question 5

HBA1c >6

Answer 5

diabetes uncontrolled

Question 6

treatment for hyperglycemia in pregnant

Answer 6

insulin
metformin
glyburide

need to control glucose levels

Question 7

diabetes in pregnancy

Answer 7

two types of patients

Question 8

1922

Answer 8

insulin discovered

Question 9

pre-gestational DM

Answer 9

mother has DM I or 2 before pregnant

Question 10

chronic hyperglycemia

Answer 10

injury to all organ systems

Question 11

class B

Answer 11

onset diabetes age 20 or older with duration less than 10 years

Question 12

class C

Answer 12

onset diabetes at age 10-19 and duration of 10-19 years

Question 13

class D

Answer 13

onset diabetes before age 10 and duration more than 20 years

Question 14

class E

Answer 14

overt diabetes with calcified pelvic vessels

Question 15

DM I

Answer 15

destruction of beta cells of pancreas
5-10% of all diabetes
1% diabetes in pregnancy

have baby that is very small

Question 16

DM II

Answer 16

90-95% cases
insulin resistance and relative insulin deficiency

most managed - lifestyle mods, diet, exercise

Question 17

diabetic pregnant

Answer 17

look at eyes, kidneys, neuropathies

get a HbA1c

Question 18

malformation in infants of diabetic mothers

Answer 18

caudal regression
spina bifida
heart anomalies
anal/rectal atresia
situs inversus

Question 19

gestational diabetes

Answer 19

during pregnancy
-first recognized when pregnant

caused by HPL - prevents body from using insulin

relative insulin resistance

long term risk fx for diabetes**

Question 20

carbohydrate intolerance

Answer 20

pancreas cannot secrete enough insulin
-increases glucose

crosses placenta
-stored in fetus - excess fat

Question 21

risk factors for GDM

Answer 21

increased maternal weight and age
previous GDM
previous macrosomic infant
fam hx diabetes
ethnic background - non-hispanic black, latino, american indian, pacific islander

Question 22

US

Answer 22

8% population have diabetes

women over 20 - half of these individuals

only 25% aware they have disease

Question 23

first trimester

Answer 23

decreased fasting blood glucose

insulin production and sensitivity increase

Question 24

end of first trimester

Answer 24

decrease sensitivity

responding increase in insulin production

creates diabetogenic state of pregnancy

Question 25

pregnant women

Answer 25

hepatic glucose production 1.3x higher than non-pregnant women

Question 26

later in pregnancy

Answer 26

increased glucose levels more hepatic production

Question 27

late pregnancy

Answer 27

diabetogenic state 20-40 weeks -increased hCS, PRL, cortisol

Question 28

complication of uncontrolled diabetes in pregnancy

Answer 28

mother ``` HTN preeclampsia miscarriage worsening of diabetes in mother vasculopathy - fetal growth restriction ketoacidosis or severe hypoglycemia ```

Question 29

baby complications uncontrolled diabetes in pregnancy

Answer 29

``` macrosomia hypoglycemia at birth** hyperbilirubin low Ca and Mg resp distress syndrome polycythemia hyperviscosity ``` increased risk for adult obesity** increased risk fo DM II**

Question 30

preterm labor

Answer 30

increased risk with GDM vascular disease, HTN, obesity - all conribute to increased risk

Question 31

pederson hypothesis

Answer 31

complications maternal hyperglycemia > fetal hyperglycemia > fetal hyperinsulin > excessive fetal growth macrosomia - difficult delivery

Question 32

poorly controlled diabetes

Answer 32

increased risk for resp distress in baby

Question 33

screening for GDM

Answer 33

don't need to do it on patient with diabetes - bc already have it

Question 34

GDM screening

Answer 34

test at risk women earlier average risk 24-28 weeks

Question 35

GDM screening test

Answer 35

50g glucose challenge test oral glucose tolerance test 75 or 100g fasting plasma glucose 126 random plasma glucose 200 **both diagnostic - no further testing

Question 36

indications for delivery with GDM

Answer 36

``` poorly controlled blood glucose abnormal fetal testing growth restriction deterioration of vascular complications significant macrosomia ```

Question 37

indications for increased surveillance

Answer 37

``` macrosomia growth restriction look at amniotic fluid elevated A1C frequent admissions during pregnancy ```

Question 38

intrapartum care for GDM

Answer 38

IV fluid therapy -administer insulin dextrose 5 drip artificially control sugar intake and insulin**

Question 39

goal blood glucose level

Answer 39

<110 to reduce hyperglycemia risk

Question 40

DM I

Answer 40

need insulin

Question 41

postpartum care for GDM

Answer 41

encourage patient to maintain blood glucose levels promote bonding and lactation with newborn educate patients

Question 42

breastfeeding

Answer 42

insulin requirements lower

Question 43

contraception

Answer 43

should address with patient during postpartum period

Question 44

goal of tx for GDM

Answer 44

keep glucose in normal range diet, exercise, daily monitoring of blood glucose, insulin, pharmacy

Question 45

exercise

Answer 45

even type 1 DM significant vasoconstriction - no exercise