Endocrine In Preg; Low Birthweight Babies

Front 1

Pregestational diabetes: further classification

Back 1

with OR without end organ dysfunction

Front 2

incidence of gestational diabetes

Back 2

3-12%

Front 3

T/F The Gestational diabetes is ketosis prone

Back 3

F

Front 4

Glucose handling in pregnancy: how does it differ?

Back 4

Accelerated starvation in ‘unfed’ state and prolonged hyperglycemia in ‘fed’ state. There is hormonal antagonism to insulin.

Front 5

Where does fetal insulin come from?

Back 5

fetal pancreas. insulin does NOT cross placenta

Front 6

Risk of DM2 following gestational diabetes

Back 6

50% over 5 years

Front 7

gestational diabetes: treatment

Back 7

1) diet - lower the amount of carbs and increase protein and fat

2) Oral hypoglycemics

3) insulin

Front 8

Fetal risks of gestational diabetes

Back 8

Macrosomia - associated with shoulder dystocia

Hypoglycemia

Hypobilirubinemia

Intrauterine fetal death

Front 9

Hypoglycemia in gestational diabetes infants: why?

Back 9

There is excess blood glucose the fetus is seeing and as a result it produces more insulin. After birth, glucose decreases, but insulin doesn't decrease as quickly.--> hypoglycemia

Front 10

How is GDM diagnosed?

Back 10

ALL women screened at 26-28 weeks.

Screen with 50 gram one hour glucose test.

If positive, follow up with more intense 100 gram 3 hour glucose tolerance test

Front 11

Development of GDM is related to what hormones?

Back 11

Anti-insulin effects of hPL. Related to mass of placenta.

Front 12

What prevents the cascade of events leading to fetal growth excess and mortality in GDM?

Back 12

Control of maternal hyperglycemia

Front 13

the growth hormone that can cause macrosomia, risk of shoulder dystocia, etc in uncontrolled DM.

Back 13

insulin

Front 14

T/F The lungs of infants born to mothers wtih GDM mature later

Back 14

T. Inreased risk of FRDS

Front 15

Target glucose goals (fasting and post-prandial) in pregnanct

Back 15

Fasting: <100
2 hour post-prandial: less than 120

Front 16

T/F Eye disease can worsen in pregnancy

Back 16

T, must see ophtho

Front 17

Rapid institution of glycemic control (IMPROVES, WORSENS) retinopathy

Back 17

worsens

Front 18

Rapid institution of glycemic control (PREVENTS, DOESN'T CHANGE) nephropathy

Back 18

prevents

Front 19

Preconception counseling for DM patient: what happens?

Back 19

Rigorous glycemic control during preconception and organogenesis emphasized.

Folic acid during organogenesis.

<b>Get hba1c in control!</b>

We would tell them that if they have end organ damage (eyes, kidneys, HTN, etc) then they are at high risk for developing severe preE early and needing premature delivery.

Front 20

Hb A1C should be below ____ to have the background/control rate of congenital abnormalities

Back 20

7.1%

Front 21

DM patients with end-organ damage are at risk for what in pregnancy?

Back 21

severe pre-eclampsia early

Front 22

Type I and Type II DM with end organ damage: babies are at risk for what and need what screening?

Back 22

IUGR andneed monthly scans for growth and probably a fetal cardiac echo to make sure heart has formed normally.

Front 23

DM mothers are usually delivered at ____ weeks

Back 23

38

Front 24

___ mildly stimulates maternal thryoid in pregnancy

Back 24

hCG

Front 25

What are the changes in thyroid hormone during pregnancy?

Back 25

1) Increase in total T4 and T3
2) Increase in thyroid binding globulin (due to increased estrogen)
3) Free T3 and T4 are the same

Front 26

Which thyroid-related hormones cross placenta?

Back 26

TSH does not cross the placenta; T4 and T3 and Thyroid immunoglobulins do..

Front 27

Hyperthyroidism in pregnancy: dx

Back 27

Same as non-pregnant.

Low TSH
High free t4 and/or t3

Front 28

Graves disease: etiology

Back 28

Associated with thyroid stimulating antibody -->hyperthyroidism

Front 29

Graves disease in pregnancy

Back 29

CROSSES placenta, can cause transient fetal hyperthyroidism at birth

Front 30

Graves disease in pregnancy: tx

Back 30

Suppress TH production with propythiouracil (PTU) or methimazole

Front 31

Uncontrolled hyperthyroidism is associated w what in pregnancy?

Back 31

preE, heart failure, PTL, IUGR IUFD, thyroid storm with stress of labor

Front 32

Thyroid storm: what is it?

Back 32

Predisposition in hyperthyroidism subjected to stress like labor, infection or surgery.

Fever, tachycardia, arryhthmia, a fib, CHF and hypotension

Front 33

Which of the DMs is most associated with increased risk of fetal anomalies?

Back 33

PREgestational

Front 34

Risk of fetal anomaly in pregestational DM can be assessed by what?

Back 34

1) HbA1c levels (should be &lt;7)

2) Maternal serum &alpha;fetoprotein

3) Detailed fetal ultrasound

Front 35

Low Birth Weight: defn

Back 35

<2500gm

Front 36

Two causes of Low Birth Weight

Back 36

1) Premature birth
2) Fetal growth restriction (small for gestational age)

Front 37

Approx ____ pregnancies are preterm births

Back 37

7-10%

Front 38

preterm birth : defn

Back 38

before 37 weeks

Front 39

Preterm births associated with what risk factors?

Back 39

HISTORY OF PRETERM BIRTH,

multiple gestations,
abnormal uterine shape,

substance abuse,
lack of prenatal care,
low SEC

Front 40

What is the etiology of link between infection and preterm birth?

Back 40

Infection increases production of prostaglandings, which stimulate uterine contractions

Front 41

Bacterial vaginosis has risk for what pregnancy complication?

Back 41

preterm birth

Front 42

How do beta 2 agonists relax uterine smooth muscle?

Back 42

They activated adenylate cyclase --> increased cAMP --> decreased MLCK ---> relaxation of uterine smooth muscle

Front 43

Racial disparities in low birth weight: which group?

Back 43

AAs at higher risk

Front 44

3 etiologies of preterm births

Back 44

1) Preterm labor (1/3)

2) Preterm premature rupture of membranes (1/3)

3) Iatrogenic due to fetal/maternal indications (pre-E, etc) (1/3)

Front 45

Labor: defn

Back 45

Cervical change ASSOCIATED with uterine contractions

Front 46

Premature cervical dilation: defn

Back 46

preterm cervical change without contractions. aka cervical incompetence

Front 47

most consistent risk factor for preterm births

Back 47

number of prior preterm births (increases)

Front 48

Braxton-Hicks contractions: defn

Back 48

preterm uterine contractions without cervical change (false labor)

Front 49

How to prevent preterm births associated with preterm labor?

Back 49

1) ID preterm labor early and give steroid to accelerate fetal lung maturation

2) Supplement patient with prior preterm birth with <b>progesterone</b>.

3) Education regarding signs and symptoms of preterm labor
(it doesn't hurt as much for some reason)

Front 50

What drug can be given to decrease preterm labor?

Back 50

progesterone

Front 51

Fetal fibronectin: defn and clinical implications

Back 51

Membrane protein that may bind chorion and amnion, is released and detectable with inflammation. Linked to increased risk of preterm birth.

Front 52

Treatment for incompetent cervix

Back 52

Cerclage - cervical stitch after first trimester

Front 53

Best use of fetal fibronectin

Back 53

Negative predictive value. If patient is laboring, and cervix is closed, may be ok to send home...

Front 54

T/F Preterm labor contractions may be milder and hurt less

Back 54

T, which is why patients must be educated about the following:

ANY intermittent abdominal/ back sensation
ESPECIALLY with history of PTL
Feel the abdomen

Front 55

Initial treatment of preterm labor (without membrane rupture)

Back 55

1) Exclude treatable etiologies (infection, dehydration)

2) Bedrest

3) Steroids

4) Tocolytics MAY be useful (where prolonging pregnancy may help fetus)

Front 56

Tocolytics work by _________

Back 56

decreasing cytosol calcium concentration

Front 57

Mg sulfate: MOA

Back 57

Reduces cytosol calcium by competitively inhibiting influx of calcium

Front 58

T/F Mg sulfate and CCBs can be used simultaneously.

Back 58

F. May have severe cardiac effects

Front 59

Other than a tocolytic, Mg Sulfate is used for ___________

Back 59

cerebral palsy prophylaxis

Front 60

Preterm premature rupture of membranes (PPROM)

Back 60

rupture prior to labor; preterm is rupture prior to 37 weeks

Front 61

risks of Preterm premature rupture of membranes (PPROM)

Back 61

1) Preterm births
2) Fetal and neonatal infection
3) Maternal risk: intraamniotic infection, postpartum endometritis

Front 62

Dx of Rupture of Membrane: clinical and lab

Back 62

clinical: leaking and/or pooling vaginal fluid

lab: dry slide ferning test: amniotic fluid ONLY ferns/crystallizes when drying

Front 63

Preterm premature rupture of membranes (PPROM) : Competing risks in delivery vs. maintain pregnancy

Back 63

Risk of delivery: prematurity and what goes along with it.

Risk of continuing pregnancy: Infection, Intrauterine fetal death

Front 64

At what gestational age do the risks of premature delivery outweigh those of maintaining pregnancy in Preterm premature rupture of membranes (PPROM)?

Back 64

<32 weeks, generally

Gray zone is 32-34 weeks

Front 65

Preterm premature rupture of membranes (PPROM) happening < 24 weeks: mgmt

Back 65

Discuss option of pregnancy termination due to poor neonatal outcome due to pulmonary hypoplasia and limb deformities

Front 66

Intrauterine fetal growth restriction (IUGR): defn

Back 66

Birthweight <10% for gestation age

Front 67

Intrauterine fetal growth restriction (IUGR): usually due to a problem with what?

Back 67

placenta

Front 68

Intrauterine fetal growth restriction (IUGR): maternal risk factors

Back 68

Maternal vascular disease - HTN, pre-E, DM, cyanotic HD, etc.

Substance use (cocaine)

Front 69

Intrauterine fetal growth restriction (IUGR): fetal causes

Back 69

Chromosomal abnormality

Congenital abnormality

Infection ESPECIALLY CMV, toxo, herpes, syphillis

Front 70

Intrauterine fetal growth restriction (IUGR): placental causes

Back 70

Abruptio placenta

Placenta previa

antiphospholipi syndrome

Front 71

Intrauterine fetal growth restriction (IUGR) caused by placenta: how to assess?

Back 71

Doppler velocimetry of umbilical artery - reveals loss of placental vascularity

Front 72

Tool to assess placental vascularity

Back 72

Doppler velocimetry of umbilical artery

Front 73

Screening of Intrauterine fetal growth restriction (IUGR)

Back 73

Fundal heights taken at each PN visit (should equal cm in weeks)

Ultrasounds of fetal growth

Front 74

Best diagnostic tool for SGA/IUGR

Back 74

Ultrasound - using fetal biometry

Front 75

When in pregnancy should a fetal etiology of growth restriction be suspected?

Back 75

When growth restriction occurs in 2nd trimester (<26-28 weeks) and/or is SYMMETRICAL

Front 76

Assymetric IUGR: implications

Back 76

Usually maternal or placental factor.

Head growth spared, Abdominal circumference lagging
Favorable outcome for catch up growth

Front 77

In the past decade, preterm birth in the United States has:
Increased
Decreased
Remain unchanged

Back 77

Remain unchanged