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REPRO II Exam 2 > Dunn OB/GYN V > Flashcards

Dunn OB/GYN V Flashcards

1
Q

society getting bigger

A

more risks for diabetes

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2
Q

american indian

A

higher risk of diabetes

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3
Q

pre-screening in obese pregnant women

A

prenatal labs
group B strep
ultrasound
HgA1c

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4
Q

> 4000g baby

A

LGA - large for gestational age

consider delivery if 37 weeks

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5
Q

HBA1c >6

A

diabetes uncontrolled

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6
Q

treatment for hyperglycemia in pregnant

A

insulin
metformin
glyburide

need to control glucose levels

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7
Q

diabetes in pregnancy

A

two types of patients

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8
Q

1922

A

insulin discovered

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9
Q

pre-gestational DM

A

mother has DM I or 2 before pregnant

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10
Q

chronic hyperglycemia

A

injury to all organ systems

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11
Q

class B

A

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

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12
Q

class C

A

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

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13
Q

class D

A

onset diabetes before age 10 and duration more than 20 years

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14
Q

class E

A

overt diabetes with calcified pelvic vessels

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15
Q

DM I

A

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

have baby that is very small

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16
Q

DM II

A

90-95% cases
insulin resistance and relative insulin deficiency

most managed - lifestyle mods, diet, exercise

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17
Q

diabetic pregnant

A

look at eyes, kidneys, neuropathies

get a HbA1c

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18
Q

malformation in infants of diabetic mothers

A 
caudal regression
spina bifida
heart anomalies
anal/rectal atresia
situs inversus
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19
Q

gestational diabetes

A

during pregnancy
-first recognized when pregnant

caused by HPL - prevents body from using insulin

relative insulin resistance

long term risk fx for diabetes**

20
Q

carbohydrate intolerance

A

pancreas cannot secrete enough insulin
-increases glucose

crosses placenta
-stored in fetus - excess fat

21
Q

risk factors for GDM

A 
increased maternal weight and age
previous GDM
previous macrosomic infant
fam hx diabetes
ethnic background - non-hispanic black, latino, american indian, pacific islander
22
Q

US

A

8% population have diabetes

women over 20 - half of these individuals

only 25% aware they have disease

23
Q

first trimester

A

decreased fasting blood glucose

insulin production and sensitivity increase

24
Q

end of first trimester

A

decrease sensitivity

responding increase in insulin production

creates diabetogenic state of pregnancy

25
Q

pregnant women

A

hepatic glucose production 1.3x higher than non-pregnant women

26
Q

later in pregnancy

A

increased glucose levels

more hepatic production

27
Q

late pregnancy

A

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

28
Q

complication of uncontrolled diabetes in pregnancy

A

mother

HTN
preeclampsia
miscarriage
worsening of diabetes in mother
vasculopathy - fetal growth restriction
ketoacidosis or severe hypoglycemia
29
Q

baby complications uncontrolled diabetes in pregnancy

A 
macrosomia
hypoglycemia at birth**
hyperbilirubin
low Ca and Mg
resp distress syndrome
polycythemia
hyperviscosity

increased risk for adult obesity**
increased risk fo DM II**

30
Q

preterm labor

A

increased risk with GDM

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

31
Q

pederson hypothesis

A

complications

maternal hyperglycemia
> fetal hyperglycemia
> fetal hyperinsulin
> excessive fetal growth

macrosomia - difficult delivery

32
Q

poorly controlled diabetes

A

increased risk for resp distress in baby

33
Q

screening for GDM

A

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

34
Q

GDM screening

A

test at risk women earlier

average risk 24-28 weeks

35
Q

GDM screening test

A

50g glucose challenge test

oral glucose tolerance test 75 or 100g

fasting plasma glucose 126
random plasma glucose 200
**both diagnostic - no further testing

36
Q

indications for delivery with GDM

A 
poorly controlled blood glucose
abnormal fetal testing
growth restriction
deterioration of vascular complications
significant macrosomia
37
Q

indications for increased surveillance

A 
macrosomia
growth restriction
look at amniotic fluid
elevated A1C
frequent admissions during pregnancy
38
Q

intrapartum care for GDM

A

IV fluid therapy
-administer insulin

dextrose 5 drip

artificially control sugar intake and insulin**

39
Q

goal blood glucose level

A

<110 to reduce hyperglycemia risk

40
Q

DM I

A

need insulin

41
Q

postpartum care for GDM

A

encourage patient to maintain blood glucose levels

promote bonding and lactation with newborn

educate patients

42
Q

breastfeeding

A

insulin requirements lower

43
Q

contraception

A

should address with patient during postpartum period

44
Q

goal of tx for GDM

A

keep glucose in normal range

diet, exercise, daily monitoring of blood glucose, insulin, pharmacy

45
Q

exercise

A

even type 1 DM

significant vasoconstriction - no exercise

REPRO II Exam 2 (21 decks)

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