Pregnancy & Gestational Diabetes Study Guide PDF

Amniocentesis o Possible after 11 wks gestation --> procedures performed *before 15 wks are associated w/ fetal loss o Common indications: prenatal genetic studies, assessment of fetal lung maturity o Withdraws amniotic fluid from uterine cavity by needle via transabdomina...

Amniocentesis o Possible after 11 wks gestation --> procedures performed *before 15 wks are associated w/ fetal loss o Common indications: prenatal genetic studies, assessment of fetal lung maturity o Withdraws amniotic fluid from uterine cavity by needle via transabdominal approach Assessment of Fetal Well-Being o Subjective- fetal movements felt by mother (kick counts) ▪ 10 fetal movements during 12 hrs of normal activity ▪ 4 movements in 1 hr when mother at rest o Objective- problems suspected or w/ multiple risk factors, fetal monitoring tests: ▪ Non-stress test (NST)- noninvasive method, records baby movement & heartbeat in response to contractions by use of external monitor (done after 26-28 weeks or prn) External transducer monitors FHR in response to fetal activity (fetal heart tracing) Reassuring: >2 HR accelerations (15 BPM above baseline, lasting 15 sec) in 20 mins ▪ If NST abnormal, move on to: ▪ Contraction stress test (CST)- after an abnormal NST (after 34 wks gestation or prn) oxytocin maybe used (Oxytocin Challenge Test (OCT), measure FHR in response to contraction ▪ Biophysical Profile (BPP)- uses US during a NST to evaluate a fetus Used more often than CST Recommended for at risk pregnancy loss, not routine Goal- prevent pregnancy loss and detect fetal hypoxia Usually done after 32 wks assesses: fetal breathing; movement; tone; & amniotic fluid volume ▪ VEAL CHOP for Fetal Acceleration Variable Early Accelerations Late Cord Compression Head Compression Okay Placental Insufficiency Patient Education o Nutrition: weight gain between 25-35 lbs, supplemental iron required, pica (often assoc. W/ anemia) o air travel ok up to 36 wks- avoid long periods of inactivity Common Symptoms o HA, edema, N/V (hyperemesis gravidarum), heartburn, constipation, fatigue, leg cramps, back pain, varicose veins, hemorrhoids, vaginal discharge 2. HTN and Gestational Diabetes in Pregnancy Hypertension in Pregnancy o Transient HTN ▪ HTN occurring in late preg w/o other features of preeclampsia & w/ normalization of BP postpartum (PP) ▪ Patho is unknown- may be forerunner of chronic HTN later o Chronic HTN ▪ BP >140 mm Hg systolic &/or 90 mmHg diastolic  ▪ Before pregnancy or before 20 wks of gestation or use of antihypertensive med before pregnancy or persistence for >12 wks after delivery ▪ Management: goal to reduce risk of CV and cerebrovascular events 2 criteria o Mild: SBP 140-159, DBP 90-109 o Severe: SBP >160, DBP 160 or Diastolic >110 Major risk- development of preeclampsia or eclampsia later on o Pregnancy Induced Hypertension (PIH) ▪ Aka gestational HTN ▪ 2nd half of preg after 20 wks ▪ *No proteinuria ▪ Develops in 5-10% preg, 30% multiple gestations, 50% progress to pre/eclampsia ▪ Causes 20% of maternal deaths, Associated w/ ^ perinatal M&M for mother and fetus o Pre-eclampsia ▪ new onset HTN w/ *proteinuria after 20 weeks gestation ▪ Mild: SBP >140, DBP >90, and proteinuria 300 mg in 24 hr urine ▪ Severe: SBP >160 or DBP > 110 and > 5 g protein in 24 hr urine ▪ Risk factors: nulliparous, >35 yrs, FMH of eclampsia, pre-existing HTN, renal disease, multiple gestation, pre-gestational DM, obesity ▪ S&S: HA, visual disturbances (blurred vision or spots-scotomata), weight gain, edema (esp. In hands or face), elevated BP, proteinuria ▪ Management of mild: prior to 37 wks: expectant management, frequent maternal & fetal evaluation, rest, monitor, testing for fetal growth restriction twice weekly, assess amniotic fluid every 3 weeks At or beyond 37 weeks: induce labor or C-section ▪ Management of severe: *MgSO4: loading dose followed by maintenance, monitor therapeutic level Titrate hydralazine to acceptable BP *Delivery is ultimate Rx o at or beyond 34 wks, induce labor or C section o Before 34 weeks, hospital admission w/ expectant management if mother is stable and fetal condition is reassuring ▪ Give corticosteroids for fetal lung maturity prior to delivery ▪ HELLP syndrome Preeclampsia with: o Hemolysis, Elevate Liver enzymes, Low Platelet count Life threatening condition, occurs w/ severe preeclampsia or eclampsia Usually occurs before the 37th weeks of preg but can occur shortly after delivery S&S: HA, worsening N/V, RUQ pain/tenderness, fatigue, malaise, visual disturbances (usually subsides w/in 2-3 days of delivery) Rx: delivery is best therapy  o >34 wks delivery, natural or Caesarian o 50% ▪ Glucose tolerance screening 2-4 mths post-partum (60-90% recurrence in subsequent pregnancies) o Child 8X more likely to develop T2DM & obesity in teens or early adulthood Clinical features Usually asymptomatic Risk factors Obesity (BMI >25) Personal or FH of DM, previous GDM Advanced maternal age, non-white ethnicity *Patho Insulin resistance occurs during preg due to placental secretion of hormones Cause postprandial (after eating) hyperglycemia & carbohydrate intolerance, allows fetus to consume more nutrients Can cause lower fasting blood glucose level, pancreas can compensate here GDM develops when pancreas cannot compensate for insulin resistance o Due to Beta cell deficits o Might have subclinical metabolic dysfunction prior to conception  Testing Risk factors & undiagnosed DM at 1st prenatal visit (do urine, not blood) *Women w/o DM: at 24-28 wks Women w/ GDM: 4-12 wks postpartum Women w/ H/O GDM: lifelong screening for pre/diabetics at least every 3 years Lab studies Screen at 24-28 weeks 50-g 1 hour oral glucose challenge. Draw blood after 3 hours: *If > or equal to 130 mg/dL requires 3-hour GTT Requires 100-g loading dose, Dx is pos if 2 of 3-hr values are increased Screen high risk patients earlier Dx GDM requires at least 2 of these values o *Fasting >95 mg/dL, 1 hr: >180 mg/dL, 2 hr: >155 mg/dL, 3 hr: >140mg/dL Rx Lifestyle modifications, best: diet and exercise Insulin- first line therapy Frequent blood sugar monitoring (4x daily), daily injections or continuous sc infusions Goal: *FBS