Questions and Answers
What threshold level is used during the 1-hour glucose tolerance test to diagnose gestational diabetes?
Which of these conditions is NOT considered a risk factor for gestational diabetes during the initial assessment?
How many glucose levels must be elevated in the 100-g OGTT for a diagnosis of gestational diabetes?
Which time frame is recommended for testing all women for gestational diabetes, except those at very low risk?
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What is the fasting glucose level that is diagnostic of gestational diabetes during the 100-g OGTT?
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What is one significant risk associated with poorly controlled glucose levels in diabetic pregnancies?
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What condition is associated with polyhydramnios in diabetic pregnancies?
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What is a normal target range for fasting AM plasma glucose in diabetic pregnancies?
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Which of the following complications is less likely to occur in diabetic pregnancies if glucose is well controlled?
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Which factor is not related to complications arising from poorly controlled diabetes during pregnancy?
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What is a major concern for mothers over 40 regarding pregnancy?
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Which statement about multiple gestations is true?
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What consequence is associated with grand multiparity?
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Which issue is increased in mothers over 35 years old compared to younger mothers?
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How does delayed childbearing affect multiple gestation rates?
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What is a common risk faced by older mothers who have unplanned pregnancies?
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Which complication is more likely in pregnancies resulting from assisted reproductive technologies?
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What condition is more pronounced in women with grand multiparity?
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What is the primary symptom of a neonatal HSV infection at 10-12 days of life?
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Which action is essential in preventing conjunctivitis in newborns exposed to Chlamydia?
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What is a common consequence for infants who are infected with syphilis?
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What is a significant risk factor for developing ectopic pregnancy in women with a history of gonorrhea?
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Which symptom associated with Neisseria gonorrhoeae infection may occur within 3 to 5 days after exposure?
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What is the primary purpose of semen analysis in male fertility testing?
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Which of the following assisted reproduction methods directly involves the injection of sperm into an ovum?
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What percentage of male infertility cases is associated with abnormal hormone levels?
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Which method of assisted reproduction involves the fertilization of ova outside the body?
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In the context of male fertility testing, which condition is identified through genetic testing?
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Which of the following statements about gonadotropin treatment is accurate?
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What physical abnormality might a urogenital examination reveal in a male fertility assessment?
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Which assisted reproduction method involves the direct placement of sperm into the uterus?
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How many different semen samples are typically examined to assess male fertility?
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Which therapy combines donor gametes with partner gametes in assisted reproduction?
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What factors contribute to a higher likelihood of adverse outcomes in adolescent mothers?
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Which age group of adolescent mothers typically experiences the greatest difficulty in confirming a pregnancy due to denial and lack of awareness?
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How may adolescent mothers aged 15-17 react to the confirmation of their pregnancy in terms of their relationships?
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What is a significant risk associated with adolescent fathers who are typically older than 20 years?
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What common response might a teenager in their second trimester have related to their pregnancy?
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What social and educational background is typical for adolescent partners of young mothers?
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What is the primary purpose of administering hCG or hMG injections to females who are not ovulating?
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Which condition is commonly associated with the use of bromocriptine in males?
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What is the typical duration for which clomiphene is administered to stimulate ovulation in women?
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Which of these is NOT a common side effect of bromocriptine?
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What specific risk is associated with the use of gonadotropins prior to harvesting ova?
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How is cytomegalovirus most commonly transmitted to the fetus?
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What is one possible consequence for neonates infected with cytomegalovirus?
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What is a common feature of herpes simplex virus infection in pregnant women?
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What is one of the significant risks of delivering a baby through a birth canal colonized by herpes simplex virus?
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What is a defining characteristic of cabergoline compared to bromocriptine?
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Study Notes
High-Risk Pregnancies
Pre-Existing Conditions
-
Gestational Diabetes Screening:
- Risk assessment at initial visit; high-risk factors include obesity, previous gestational diabetes (GDM), glycosuria, polycystic ovary syndrome (PCOS), and family history of type 2 diabetes.
- Universal testing for women not at very low risk between 14-28 weeks of gestation.
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Screening Methods:
- 50g glucose load test: >140 mg/dL indicates further testing; 100-g oral glucose tolerance test (OGTT) confirms diagnosis with specified glucose levels.
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Complications in Pregnancies with Diabetes:
- Increased risk of diabetic ketoacidosis, pregnancy-induced hypertension (preeclampsia), and retinopathy.
- 10% of diabetic pregnancies may experience polyhydramnios (>2000 mL amniotic fluid).
- Poor glucose control significantly raises risk of spontaneous abortion and urinary tract infections.
Maternal Age
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Adolescent Mothers (15-19 years):
- Risks include smoking, inadequate weight gain, premature delivery, low birth weight, and teen-related health complications.
- Higher rates of sexually transmitted diseases (STDs) and substance use are prevalent.
- Developmental concerns affect the mother and partner, impacting support and parenting.
-
Teenage Pregnancy Responses:
- Age ≤14: Often due to abuse; little support; lack of self-esteem.
- Age 15-17: Concern about rejection; more knowledgeable about options.
- Age 18-19: Better understanding of pregnancy; decision-making influenced by support systems.
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Older Mothers (Over 35 years):
- Increasing numbers due to delayed childbearing; often more educated and financially stable.
- Risks include higher C-section rates, pre-existing health issues (diabetes, hypertension), and fetal complications (increased chance of Down syndrome).
Multiple Gestations
- Increased rates of multiples due to assisted reproductive technology (ART) and delayed childbearing.
- Higher incidence of premature birth and low birth weight correlated with the number of fetuses; significant discrepancies in growth are common.
- Morbidities associated with prematurity include cerebral palsy and intellectual disabilities; genetic disorder risks are increased in multiples.
Grand Multiparity
- Defined as 25 or more pregnancies (including stillbirths) at ≥20 weeks gestation.
- Associated with increased risks of placenta previa, preeclampsia, and hemorrhage; higher C-section rates.
- Proper prenatal care can mitigate risks; complications such as macrosomia and malpresentation are common.
Infertility
Female Infertility Causes
- Various factors, including hormonal imbalances and anatomical issues.
Male Fertility Testing
- A thorough urogenital history and examination, including semen analysis and hormone evaluation.
- Genetic testing for conditions like Klinefelter syndrome and Y chromosome deletion.
Assisted Reproductive Methods
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Options include:
- ART with donor egg/sperm.
- Gamete intrafallopian transfer (GIFT) and intrauterine insemination (IUI).
- In vitro fertilization (IVF) and zygote intrafallopian transfer (ZIFT).
Gonadotropin Treatments
- Administered to stimulate follicle maturation and ovulation; requires close monitoring for side effects.
Fertility Drugs
- Bromocriptine: Reduces prolactin to enhance ovulation; administered orally or vaginally.
- Clomiphene: Stimulates hormone production in women; used to increase sperm count in men.
Sexually Transmitted Diseases (STDs)
- Cytomegalovirus: Most common intrauterine viral infection; can lead to severe neurological disorders in infected infants.
- Herpes Simplex Virus (HSV): High risk of transmission during delivery; neonatal infections can cause serious complications.
- Chlamydia: Leads to conjunctivitis in newborns; routine prophylaxis required post-birth.
- Syphilis: Can cause severe systemic infections in newborns, requiring aggressive treatment with penicillin.
- Gonorrhea: Increases risks of PID and ectopic pregnancies; aggressive treatment necessary.
- Human Papillomavirus (HPV): Causes genital warts; some types associated with cervical cancer.
Substance Abuse Effects on Pregnancy
- Marijuana: Mixed effects, but no clear teratogenicity. Can lead to withdrawal symptoms in neonates.
- PCP: Risk of overdose presenting serious health threats to both mother and fetus.
- MDMA: Potential long-term learning impairments in offspring.
- Amphetamines: Cause significant cardiovascular issues and developmental delays in newborns.
- Cocaine/Crack: Potent vasoconstrictor that poses severe risk of placental damage and fetal hypoxia.### Cocaine
- Maternal cocaine use constricts blood vessels, severely compromising placental blood supply.
- Compromised blood flow can lead to fetal growth restriction and hypoxia.
- Apoptosis in fetal heart muscle cells due to cocaine use results in cardiac dysfunction.
- Increased risk of premature birth and severe neonatal consequences include cerebral infarctions and gastrointestinal defects.
- Cocaine stimulates the central nervous system by limiting neurotransmitter uptake, affecting norepinephrine, serotonin, and dopamine levels.
Heroin
- An illegal, highly addictive opioid narcotic associated with significant health risks.
- Users are at greater risk for HIV/AIDS through needle sharing.
- Can lead to poor maternal nutrition and complications like pre-eclampsia.
- Consequences for pregnancy include premature birth, placental issues, and breech presentation.
- Withdrawal from heroin may result in premature labor or stillbirth, with symptoms including agitation and gastrointestinal distress.
- Methadone maintenance programs help manage withdrawal while posing less danger to the fetus; withdrawal symptoms after birth are often transient.
Methadone
- Used to treat heroin addiction during pregnancy by blocking withdrawal symptoms and cravings.
- Crosses the placenta, potentially leading to fetal complications such as growth restriction and distress.
- Methadone exposure generally results in milder withdrawal symptoms compared to heroin.
- Sudden withdrawal can trigger serious risks, including preterm labor or fetal demise.
Alcohol and Fetal Alcohol Syndrome (FAS)
- Maternal alcohol consumption can lead to FAS, characterized by multiple birth defects.
- No safe amount of alcohol during pregnancy has been established; abstinence is recommended.
- Physical facial abnormalities include underdeveloped facial structures and short eye slits.
- Neurological deficits manifest as microcephaly, learning disorders, and motor delays.
- Behavioral issues such as hyperactivity and judgment problems may also occur.
- Alcohol-related neurodevelopmental disorder (ARND) indicates brain damage without physical defects.
Tobacco/Nicotine
- Tobacco smoke exposes the fetus to harmful substances like carbon monoxide and nicotine.
- Increased risks associated with maternal smoking include miscarriages, low birth weight, and higher rates of spontaneous abortion.
- Smoking complicates pregnancy outcomes such as premature labor and urinary tract infections.
Termination of Pregnancy - Surgical Procedures
- Various surgical methods for abortion include:
- Vacuum aspiration (up to 10 weeks).
- Suction curettage (6 to 14 weeks) involves suctioning followed by looped curettage.
- Dilation and extraction (14 to 24 weeks) extracts the fetus followed by suctioning.
- Intact dilation and extraction (>18 weeks) requires feticide to prevent live birth.
- Hysterectomy/hysterotomy (12 to 24 weeks) is used as a last resort.
Medical Procedures for Medical Abortion
- Medical abortion methods are available primarily in the first trimester.
- Mifepristone is administered on day 1 to block progesterone's effects, followed by misoprostol to expel fetal tissue.
- Methotrexate can also be used to halt growth, followed by misoprostol for expulsion.
- Supervision is required due to the potential for heavy bleeding and complications during medication-induced abortion.
- Follow-up examinations ensure that the abortion process is complete.
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Description
This quiz covers the clinical practice recommendations for gestational diabetes as outlined by the American Diabetes Association. It focuses on risk assessment and testing procedures related to pre-existing conditions that may affect pregnancy. Understand the key factors that determine the risk for gestational diabetes to improve maternal and child health.
