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16 Cards in this Set
- Front
- Back
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Pathophysiology of GDM.
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Early gestation: decreased insulin requirements, inc'd insulin sensitivity and secretion
Mid gestation: inc'd insulin secretion in response to glucose challenge Late Gestation: decrease in peripheral insulin sensitivity Normally compensate by inc'd insulin response Gestational DM: can't compensate |
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Pre-Existing DM vs GDM:
Diagnosis |
Pre-Existing DM:
HgA1C>6.5 Fasting glucose>126 (at first prenatal visit) GDM: Routine screening at 26-28 weeks-- (screen early if have risk factors) Screen: 50g glucose load; >130 or >140 Confirm: 3hr glucose tolerance test More than 2 abnl values |
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Causes of decreased insulin sensitivity in pregnancy
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Placental mediators:
Human placental lactogen Cortisol E/PG |
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Risk factors of GDM
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Obesity
Adv'd maternal age History GDM History DM Multiple Gestations |
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GDM: Treatment
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1) Carb controlled diet
Fasting glucose <90-95 2 hour post-prandial <120 2) If glucose doesn't normalize to above values: Insulin (NPH am/pm; Humalog cc) Glyburide (NOT METFORMIN--affects fetal liver) maybe |
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Maternal Complications of GDM
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Macrosomia: baby >4500 grams (worrisome for birth; shouldedystocia)
Polyhydramnios Stillbirth |
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Neonatal Complications of GDM
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Neonatal Metabolic Derangements
Respiratory Distress Syndrome Hypoglycemia Polycythemia Hyperbili/hypocal |
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DGM Prognosis
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50% of patients with GDM are later diagnosed with DM II within 20 years
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Preeclampsia:
Definition Diagnosis |
HTN with assocd proteinuria after 20 weeks of gestation
HTN: >140/90 x 2; 6 hours apart Proteinuria: >300 mg in a 24 hour specimen |
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Risk Factors of Preeclampsia
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Nulliparity
AA Age <20 Obesity Existing medical conds (Chronic HTN, DM, SLE) |
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Symptoms of Preeclampsia
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HA, vision changes
Nausea, Vomiting, epigastric pain, RUQ pain Oliguria, Anuria SOB |
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Lab abnormalities seen in preeclampsia.
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CBC: hemoconcentration, thrombocytopenia
Renal fn: Cr elevation, Uric Acid elevation Elevated LFTs |
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Eclampsia
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Preeclampsia + seizures
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Severe Preeclampsia:
Diagnosis Fetal Effects |
BP >160/110
24º U Prot >5g Maternal kidney dysfn, pulm edema, HA, visual disturbances, RUQ pain, impaired liver fn, thrombocytopenia Fetal Fx: Growth restriction Oligohydramnios |
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HELLP syndrome:
Diagnosis Associated Complications (Maternal and Fetal) |
H-emolysis (schistocytes)
E-levated L-FTs L-ow P-latelets ***********Not all have HTN****** Comp: Maternal: Pulm edema, abruption, hemorrhage (DIC), renla failure, liver hematoma Fetal still birth, growth restriction |
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HELLP:
Treatment |
DELIVERY DELIVERY DELIVERY
BP control: labetalol, nifedipine Seizure prophylaxis: Mg Sulfate (phenytoin is an alternative) Steroids in thrombocytopenia pRBCs, platelets for blood replacement |
