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1

Risk factors for GDM

Obesity, previous history, strong family history, known glucose intolerance

2

Complications (mom) of GDM

- HTN
- Preeclampsia
- C-section
- DM later

3

Complications (fetus) of GDM

- Macrosomia
- Hypoglycemia @ birth
- Hyperbilirubinemia
- Operative delivery
- Shoulder dystocia
- Birth trauma

4

Pre-gestational DM is most crucial in what time period?

Embryogenesis - birth defects (6x increase)

5

How to screen for GDM?

When do you screen? Why?



Negative value (1 hr)?

Glucose tolerance test

26-28 weeks (hPL is at highest, will make you glucose intolerant if it's gonna happen at all)

Less than 135

6

When are you diagnosed w/ GDM?

Treatment?

2+ abnormal GTT values (1 hr + 3 hr tests)

Diet counseling, oral hypoglycemic meds (glyburide), insulin

7

Normal blood glucose fasting level (w/ treatment)

Normal post-prandial (2 hr) glucose level (w/ treatment)

Less than 90

Less than 120

8

Maternal complications of GDM?

Main fetal complication? Requires what? Risk for what?


Other important complications?

DM later, birth trauma, HTN, preeclampsia

Macrosomia (large abdomen)
- C-section
- Risk for shoulder dystocia (can't get belly out at birth)

Intrauterine death, hyperbilirubinemia, operative delivery, birth trauma

9

A baby greater than ____ must be delivered via C-section

4500 grams

10

32 G2P1 at 14 weeks, has had DM for 7 years, takes Metformin and Glyburide. High HbA1c

Maternal complications? (3)

Baby defects? (4)

- Worsening retinopathy or nephropathy
- Preeclampsia
- DKA


- ***Fetal cardiac defects
- Spontaneous aboriton
- Growth restrictions
- Prematurity

11

Studies to evaluate maternal health in DM pregnancy? (5)

- Kidney function
- EKG (vascular dz)
- Ophthalmology
- Thyroid studies
- Glycemic control

12

Studies to evaluate fetal health in DM pregnancy? (5)

- Ultrasound for dating, etc
- Biochemical testing/nuchal translucency
- Detailed ultrasound for fetal anatomy (EKG, etc.)
- Growth ultrasounds
- Antenatal testing

13

How to deliver DM pregnancy? When?

Vaginal - try to get to wk 39 (lungs mature slower than normal)

14

25 G3P1 at 30 weeks, has fever and tachycardia. Diaphoretic. Overactive thyroid and can't remember what drugs she takes...

Dx?

Thyroid storm

- Beta blockers
- IV fluids
- Antipyretics
- PTU/Methimazole

15

Fetal effects w/ hyperthyroidism

- Fetal goiter (can't deliver)
- Fetal hypothyroidism

16

How to treat hyperthyroidism in pregnancy?

PTU - 1st trimester (hepatotoxicity after)

Methimazole - 2nd/3rd (aplasia cutis before)

17

How to treat hypothyroidism in pregnancy?

Monitor? Like in what else?

Thyroid replacement (levothyroxine)

TSH and free T4 (just like in hyperthyroidism)

18

Fetal effects from untreated hypothyroidism

- CRETINISM
- Spontaneous abortion
- Preeclampsia
- Abruption
- Low birth weight
- Stillbirth
- Lower intelligence

19

28, G2P1 at 28 weeks, pain in calf that is red, swollen and tender. Obese. Palpates a cord on palpation.

Most important test?
Dx?
Risk factors? (2)
Tx?

LE venous doppler

Superficial thrombophlebitis (NOT DVT)

Sedentary, pregnant

Tylenol, ice, heat, etc.

20

35, G1P1, 6 weeks post-partum. Pain in R calf worse with walking. Edema and tenderness, bigger than L calf. Pain w/ dorsiflexion...

Testing?
Dx? Why?
Tx?
Med monitoring? (3)
Long-term management? (3)

LE venous doppler

DVT - from pregnancy

Anticoagulation (Lovenox, then Warfarin)

INR (once on Warfarin)
Factor Xa (Lovenox)
aPTT (Heparin)

3-6 months post-partum, prophylax future pregnancies, NO combo OCPs

21

Treating DVT DURING pregnancy? Why?

Lovenox, then Heparin at 36 weeks until birth (can be reversed before birth)

22

29, G1 at 30 weeks w/ pleuritic chest pain, shortness of air and palpitations. 2 months ago complained of back pain, pelvic pain, leg pain, and headaches. Coughing up blood now.

Dx?
Findings on PE?
How to evaluate? (5)
Tx?
Work-up?

PE

Tachypnea, tachycardia, fever, pleural friction rub, chest splinting, pulmonary rales, accentuated pulmonic valve S2

V/Q scan or CT angiography, ABG, EKG, CXR

Anticoagulation (Lovenox, then Heparin at 36 wks)

Thrombophilia workup (LAC, Factor V Leiden, Protein C and S, AT3, Prothrombin mutation)

23

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