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18 Cards in this Set
- Front
- Back
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What is the etiology of gestational diabetes?
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Placenta secrets diabetogenic hormones:
Human placental lactogen (hPL) Insulinase Other hormones: growth hormone, Cortisol Progesterone. The decreased exercise / increase in maternal adipose deposition and caloric Inability of the pancreas to compensate for the insulin resistant state of pregnancy. |
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What is are the classifications of diabetes in pregnancy?
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Overt
FPG ≥ 126 mg/dL [7.0 mmol/L] RPG ≥ 200 mg/dL [7.0 mmol/L], confirmed by A1c or FPG A1C ≥6.5 percent Gestational Fasting plasma glucose ≥92 mg/dL [5.1 mmol/L], but <126 mg/dL [7.0 mmol/L] at any gestational age At 24 to 28 weeks of gestation: 75 gram two hour oral glucose tolerance test (GTT) with at least one abnormal result |
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What is the glucose challenge test for screening for gestational diabetes?
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1) Give 50 g oral glucose without regard to time of day.
2) Measure plasma or serum glucose 3) Glucose > or = 130mg/dL is abnormal. |
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What is the treatment for gestational diabetes?
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Glucose monitoring
Nutritional therapy Achieve normoglycemia Prevent ketosis Provide adequate weight gain Contribute to fetal well-being Insulin (insulin requirements usually lower during delivery!) Oral hypoglycemic agents |
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What are the categories of hypertension in pregnancy?
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Chronic Hypertension
Gestational Hypertension Preeclampsia Preeclampsia superimposed on Chronic Hypertension |
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What is chronic hypertension?
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“Preexisting Hypertension”
Definition Systolic pressure ≥ 140 mmHg, diastolic pressure ≥90 mmHg, or both. Presents before 20th week of pregnancy or persists longer then 12 weeks postpartum. Causes Primary = “Essential Hypertension” Secondary = Result of other medical condition (ie: renal disease) |
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What is the prenatal care for chronic HTN?
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Electrocardiogram should be obtained in women with long-standing hypertension.
Baseline laboratory tests Urinalysis, urine culture, and serum creatinine, glucose, and electrolytes Tests will rule out renal disease, and identify comorbidities such as diabetes mellitus. Women with proteinuria on a urine dipstick should have a quantitative test for urine protein. |
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What is the treatment for chronic HTN?
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Medication choices
All anti HTN meds cross placenta Avoid ACE I, ARB, and renin inhibitors Oral methyldopa and labetalol are preferred |
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Why is pregnancy-induced HTN a concern?
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Hinderance of blood flow in many different organ systems in the expectant mother including the liver, kidneys, brain, uterus, and placenta.
Placental abruption (premature detachment of the placenta from the uterus) Intrauterine growth restriction (poor fetal growth) and stillbirth. If untreated, severe PIH may cause dangerous seizures and even death in the mother and fetus. Because of these risks, it may be necessary for the baby to be delivered early, before 37 weeks gestation. |
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What is preeclampsia?
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Definition = New onset of hypertension and proteinuria after 20 weeks gestation.
Systolic blood pressure ≥140 mmHg OR diastolic blood pressure ≥90 mmHg Proteinuria of 0.3 g or greater in a 24-hour urine specimen Preeclampsia before 20 weeks, think MOLAR PREGNANCY! Categories Mild Preeclampsia Severe Preeclampsia Eclampsia Occurrence of generalized convulsion and/or coma in the setting of preeclampsia, with no other neurological condition |
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What is mild vs. severe preeclampsia?
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MIld:
- HTN - Water retention - Protein in urine Severe (CNS symptoms): - HA - blurred vision - photophobia - fatigue - N/V - oliguria - pain in upper right abdomen - SOB - Easy bruising (liver problem) - fetal growth restrictions |
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What is preeclampsia superimposed on chronic HTN?
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Affects 10-25% of patients with chronic HTN
Preexisting Hypertension with the following additional signs/symptoms: New onset proteinuria Hypertension and proteinuria beginning prior to 20 weeks of gestation. A sudden increase in blood pressure. Thrombocytopenia. Elevated aminotransferases. |
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What is the treatment of preeclampsia?
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Definitive Treatment = Delivery
Major indication for antihypertensive therapy is prevention of stroke. Diastolic pressure ≥105-110 mmHg or systolic pressure ≥160 mmHg Choice of drug therapy: Acute/Severe – IV labetalol, IV hydralazine, SR Nifedipine Long-term – Oral methyldopa or labetalol |
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What is gestational HTN?
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Mild hypertension without proteinuria or other signs of preeclampsia.
Develops in late pregnancy, after 20 weeks gestation. Resolves by 12 weeks postpartum. Can progress onto preeclampsia. Often when hypertension develops <30 weeks gestation. Indications for and choice of antihypertensive therapy are the same as for women with preeclampsia. |
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How do you evaluate HTN in pregnancy?
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Laboratory Tests
CBC (Hgb, Plts) Renal Function (Cr, UA, Albumin) Liver Function (AST, ALT, ALP, LD) Coagulation (PT, PTT, INR, Fibrinogen) Urine Protein (Dipstick, 24 hour) |
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How do you manage HTN in pregnancy?
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Depends on severity of hypertension and gestational age!!!!
Observational Management Restricted activity Close Maternal and Fetal Monitoring BP Monitoring S/S of preeclampsia Fetal growth and well being (Non Stress Testing, and U/S) Routine weekly or biweekly blood work |
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what is the medical management of HTN in pregnancy?
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Medical Management
Acute Therapy = IV Labetalol, IV Hydralazine, SR Nifedipine Expectant Therapy = Oral Labetalol, Methyldopa, Nifedipine Eclampsia prevention = MgSO4 Contraindicated antihypertensive drugs ACE inhibitors Angiotensin receptor antagonists |
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What is eclampsia?
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If the seizure is witnessed,
maintenance of airway patency and prevention of aspiration The patient should be rolled onto her left side. A bed with raised, padded side rails provides protection from trauma. Supplemental oxygen(8 to 10 L/min) via a face mask has been recommended The immediate issues in caring for an eclamptic woman include: Prevention of maternal hypoxia and trauma Management of severe hypertension, if present Prevention of recurrent seizures Evaluation for prompt delivery. The definitive treatment of eclampsia is delivery Treat with hydralazine or labetolol. |
