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11 Cards in this Set
- Front
- Back
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Why do the 1st and 2nd/3rd trimesters differ so greatly in carbohydrate metabolism?
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In the 1st trimester the placenta is still developing so the baby is taking (via diffusion) what it needs, including lots of glucose for its development. The mother feel tired, n/v due to low blood sugar (Type i insulin requirement will go down in 1st trimester)
In the 2nd ant 3rd trimesters the placenta is formed and producing its own hormones that influence carb metabolism. Type I will need MORE insulin now |
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Diabetic ketoacidosis and pregnancy
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Remember that ketones are acids. Pregnant women can go into ketoacidosis quickly, it is very dangerous to mother and baby (up to 50% mortality for baby)
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Osmotic diuresis in pregnant diabetics
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Diabetic will try to get rid of excess glucose by diuresis but they lose water as well --> dehydration, a setup for metabolic acidosis
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Are diabetics at greater risk for PIH?
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YES!
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Why are diabetics at an increased for c/s or instrumented birth?
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macrosomia, fetal distress, induction failure, vascular changes in placenta can lead to nonreassuring EFM
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When are pregnant diabetics considered high-risk?
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ALWAYS!!
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Delayed fetal lung maturing in diabetics
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Hyperglycemia interferes with production of pulmonary surfactant so may not be present until 38-39 weeks gestation. Therefor will not induce or section a mother at 37 weeks until know fetal lung maturity. Corticosteroids will make mothers blood sugar go up, anticipate this and watch very closely to give more insulin. NOTE: that steroids are only given before 34 weeks b/c they are only proven up to this point
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Summarize insulin requirements throughout pregnancy
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1st trimester: decreased requirements
2nd and 3rd trimesters: requirements steadily climb until 36 weeks |
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Who will get a biophysical profile and how often?
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1. Type 1 diagetics: 32 wks until delievery, every week
2. If IUGR or PIH: 26-28wks until delivery 3. Type II diabetic: 40wks until delivery |
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Risk for maternal mortality based on Group (not Grade)
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Group 1: <1%, minimal risk of complications, can fluctuate HR
Group II: 5-15%, moderate risk of complications, symtomatic at rest, fixed CO Group III: >25%, major risk of complication or death |
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What is the delivery of choice for a patient with a cardiac lesion?
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vaginal delivery with epidural anesthesia, they will need a swan catheter
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