Wed- DM in pregnancy and ectopics Flashcards Preview

Year2 Repro exam II > Wed- DM in pregnancy and ectopics > Flashcards

Flashcards in Wed- DM in pregnancy and ectopics Deck (56):
1

What is class B DM

onset at age 20 or older with duration less than 10 yrs

2

what is class C DM

onset age 10-19 duration 10-19 years

3

what is class D DM

onset before age 10 duration >20 yrs

4

what is class E DM

over DM with calcified pelvic vessels

5

what is class F DM

diabetic nephropathy

6

class R DM

proliferative retinopathy

7

class RF DM

retinopathy and nephropathy

8

class H DM

ischemic heart disease

9

class T DM

prior kidney transplant

10

what is DM I

destruction of beta cells o pancreas
absolute insulin deficiency

11

what is DM II

insulin R and relative insulin deficiency

12

how to manage DM II

lifestyle modification, diet, exercise, pharm

13

what is gestational DM

any degree of glucose intolerance with onset or first recognition during pregnancy

14

what causes gestational DM

condition in which a hormone made by placenta prevents body from using insulin effectively

15

what is risk of DM after GDM

50-70%

16

what happens to excess glucose in GDM

stored as fat in the fetus

17

risk factors GDM

increasing maternal age and weight
previous GDM
previous macrosomic infant
FMH DM
ethnic background with increased DM

18

what occurs to metabolism in first trimester

fasting blood glucose decreases from insulin production and sensitivity increases

19

what occurs to metabolism after first trimester

insulin sensitivity decreases
increase in insulin production

20

how is euglycemia maintained in pregnancy

beta cells produce enough insulin to counteract increasing resistance

21

complications GDM

HTN
preeclampsia
SAB
worsening of DM complicaitons
fetal growth restriction with vasculopathy
ketoacidosis or severe hypoglycemia

22

complications of GDM for baby

macrosomia
hypoglycemia at birth
hyperbilirubinemia
low ca and Mg
RDS
polycythemia
hyperviscosity
increased risk for childhood and adult obesity
increased risk DM II later in life

23

risks of preterm birth

GDM
uncontrolled preexisting DM
vascular disease
HTN disorders
obesity

24

what are the tests to order for GDM

50 g glucose challenge test
oral glucose tolerance test, 75 or 100g

25

what glucose levels are Dx for GDM

fasting plasma glucose of 126
random plasma glucose of 200

26

indications for delivery in GDM

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

27

indications for increased surveillance uring labor

macrosomia
growth restriction
abnormal level of amniotic fluid
uncontrolled blood glucose
elevated A1C
frequent hospital admissions during pregnancy
little or no prenatal care

28

what to do in a woman with DM with anticipated labor 6-8 hours

IV dextrose administered hourly at a rate of 100ml to 150ml

29

what level of blood glucose in maintained during labor to reduce risk of maternal and fetal hyperglycemia

<110

30

what patients must have insulin during labor

DM I

31

immediatley postpartum what occurs to metabolism

insulin resistance dramatically improves

32

what therapy is used when mother is breastfeeding

oral anti-DM medications

33

pregestational DM are at increased for what when they breast feed

episodes of hypoglycemia

34

Tx for pregestational DM woman who is breast feeding

eat a 15 g carb snack before or during breastfeeding

35

Tx for GDM

special diet
exercise
daily blood glucose monitoring
insulin injections
pharm management

36

what must you check before advise patient with GDM to use exercise as a Tx method

vascular complications

37

when can a patient with GDM exercise

if blood sugar >250 and negative ketones

38

when should a patient with GDM definitely not exercise

bloos sugar level>250 and ketones +

39

tests to order for 23 y.o complaining of intermittent bleeding and LMP

pregnancy
UA
pap
cultures
CBC
platelet count +
US +

40

in a normal pregnancy what does hCG do

double every 48 hours

41

if abnormal pregnancy what does hCG do

hCG can stay the same, decrease or increase minimally

42

risks associated with 1st trimester bleeding

miscarriage
abnormal placenta implantation
IUGR

43

an abnormal pregnancy can be what

missed abortion
complete abortion
incomplete abortion
molar pregnancy

44

risk factors for spontaneous abortions

maternal age (older the higher)
previous spont abortion
prolonged time to implantation interval
prolonged time to conception
smoking
EtOH
cocaine
NSAIDs
caffeine
low folate levels
extremes of maternal weight
fever during early pregnancy
unrecognized celiac disease

45

what are fetal causes of spontaneous abortions

chromosomal abnormalities
congenital abnormalities
trauma

46

what are maternal causes of spontaneous abortions

uterine structural issues
acute maternal infections
maternal endocrinopathies
hypercoagulable states

47

Sx for spontaneous abortions

vaginal bleeding
pelvic pain
absence of fetal movement
incidental finding on US/ hand-held Doppler

48

labs to order for spontaneous abortion

hand held doppler
pelvic exam
pelvic US
hCG
blood type Ab screen
serum progesterone

49

what is criteria for spont abortion on pelvic US

gestational sac >25 mm without yolk sac or embryo
embryo with crown rump length that does not have cardiac activity

50

Tx for threatened abortion

bed rest and expectant management

51

50% threatnened abortions will have wha toutcome

miscarriage

52

Tx options for inevitable abortion

medical
surgical
expectant management

53

Tx options incomplete abortion

medical abortion (misoprostol)
surgical abortion (D&C)
expectant management of infections

54

Tx completed abortion

examination of passed tissue to confirm products of conception
transvaginal US to see empty uterus
follow hCG levels until zero

55

risk factors ectopic pregnancy

previous ectopic
PID
assisted repro technology
history peritonitis
smoking
previous tubal ligation

56

Tx ectopic pregnancy

MTX- folic acid inhibitor
surgical- removal of ectopic
removal of tube