GDM

• identification of complications

• referral

• management of complication

3 delays that lead to maternal and neonatal deaths

diabetes mellitus

• chronic metabolic disorder characterized by a deficiency in insulin production by the islets of Langerhans, altered insulin secretion and utilization, or the effect of the metabolic changes in pregnancy on insulin production and utilization resulting to improper metabolic interactions of carbs, fats, proteins, and insulin

gestational diabetes mellitus

• increased antagonistic hormones produced by the placenta (cortisol, estrogen, progesterone, and human chorionic somatomammotropin/human placental lactogen) prevent the body from using insulin effectively

  • glucose builds up in the blood instead of being absorbed by the cells

cortisol, estrogen, progesterone, human chorionic somatomammotropin, human placental lactogen

GESTATIONAL DIABETES MELLITUS

• increased antagonistic hormones produced by the placenta (?, ?, and ?/?) prevent the body from using insulin effectively

  • glucose builds up in the blood instead of being absorbed by the cells

T

T or F: client’s glucose crosses the placenta, but insulin does not

macrosomia

• fetus produces its own insulin and pulls glucose from the pregnant individual to hypoglycemic reactions

• 4000-4500 grams or 9 lbs

4000-4500 g or 9 lbs

how much does a neonate with macrosomia weigh? (both g and lb)

24-28

diagnosing GDM is performed between ? and ? weeks of gestation

1. 50, 100

2. HBA1C

3. glucosuria

DIAGNOSING GDM

1. 2 step approach (? and ? grams oral glucose)

2. glycated hemoglobin (?)

3. urine glucose monitoring (?)

oral glucose tolerance test

• 2 step appr

12 midnight

When taking the 2nd step of the OGTT, when should you start to fast?

• 2

• 105

• 190

• 165

• 145

OGTT

• ? out of 4 venous results are considered abnormal

• fasting blood sugar: > ? mg/dl

• 1 hr after: > ?

• 2 hrs after: > ?

• 3 hrs after: > ?

• polyphagia

• polydipsia

• polyuria

• glucosuria

• weight loss

signs and symptoms of GDM

polyphagia

excessive hunger

polyuria

excessive urine

polydipsia

excessive thirst

glucosuria

sugar in urine

euglycemia

term for normal blood sugar level

• cesarean section

• yeast infection, urinary tract infection

• spontaneous abortion

EFFECTS OF DM ON THE MOTHER

• ?

• infection: ? and ?

• ?

polyhydramnios

• > 2000 ml anmniotic fluid

• too much amniotic fluid

• fluid: > 1500-2000 ml

early breastfeeding

treatment for macrosomia

• amniocentesis

• artificial rupture of membrane

• indomethacin

treatment for polyhydramnios

amniocentesis

• diagnostic procedure in which a needle is inserted through the maternal abdominal wall into the uterine cavity to obtain amniotic fluid

• lecithin-sphingomyelin ratio (L/S 2:1)

• phosphatidyl-glycerol (PG) = innate immune defense against potential lung pathogen

• lecithin-sphingomyelin ratio

• phosphatidyl-glycerol

• used to assess lung maturity

• nasa amniocentesis

dystocia

• broken clavicles

• prolonged difficult labor and delivery because of problems with the 5 P’s

• power

• passenger

• passageway

• position

• psyche

what are the 5 P’s

120-160 bpm

normal FHR on doppler

110-160 bpm

normal FHR on cardiotocogram

• cs

• fetus

• under 35

• less, 5

INDICATIONS OF OXYTOCIN:

• no history of ?

• ? is in good condition

• (under / over) ? years old

• (less / more) than para ?

1. Diet

2. Insulin

3. Exercise

DM MANAGEMENT

1. ?

   • cornerstone of DM management and control

   • calories: 35 cal/kg, 1800-2000 daily

   • carbs: 200 mg/day, 3 meals and 2 snacks

   • protein: 70 g daily

   • fats: unsaturated

2. ?

3. ?

   • decreases the need for insulin

   • 30 mins at least 5x a week

• 35, 1800-2000

• 200, 3, 2

• 70

• unsaturated

DM MANAGEMENT

DIET:

• calories: ? cal/kg, ? to ? daily

• carbs: ? mg/day, ? meals and ? snacks

• protein: ? g daily

• fats: ?

30, 5

DM MANAGEMENT

EXERCISE:

• ? mins at least ? times a week

subcutaneous

what is the route when administering insulin

upper thigs, abdomen, upper arms

what are the locations when administering insulin

30

? mins after insulin, give meal

2-4

inject insulin slowly ? to ? seconds

glyburide, metformin

oral meds

short, intermediate

?-acting and ?-acting insulins are always the one being used

T

T or F: you should eat after exercise

• shaking or trembling

• faster HR

• extreme hunger

• sweating

• confusion/difficulty concentrating

• dizziness

symptoms of hypoglycemia

• 15, complex

• 15

HYPOGLYCEMIA

• If conscious, take ? grams of ? carbohydrates:

• retest after ? mins

• 3

• ½

• 6

• 1

• <70

HYPOGLYCEMIA

• If conscious, take 15 grams of complex carbohydrates:

  • ? glucose tablets/ glucose gel

  • ? cup of fruit juice or regular soft drink

  • ? crackers

  • ? tablespoon of hopney syrup

• retest after 15 mins

  • if ?, repeat carbohydrate intake

10 kicks within 2 hrs

normal fetal kick counts

non stress test

• acceleration of heartbeat

• cardiotocogram

• screening tool that uses electronic fetal monitoring (EFM) to assess fetal condition or well-being

contraction stress test

• deceleration of heartbeat

• <110 bpm

• because u gave oxytocin for contraction

• to identify a fetus that is at risk for compromise through observation of the fetal response to intermittent reduction in utero placental blood flow associated with stimulated uterine contractions

8-10

normal biophysical profile

F

T or F: you should not void when doing the non stress test

semi fowler or side-lying

position of mother when doing non stress test

reactive nst

reactive or non reactive nst?

• 2 or more FHR accelerations of 15 beats/min lasting 15 seconds or more within 20 mins

• related to fetal mvmt

nonreactive nst

reactive or non reactive nst?

• tracing without FHR accelerations or with accelerations of fewer than 15 beats/min lasting less than 15 seconds throughout fetal mvmt

1. FHR

2. nipple stimulation

3. oxytocin, 3

CONTRACTION STRESS TEST PROCEDURE:

1. ? for 20 mins

2. ? for 10 mins

3. ? via IV until ? uterine contractions in 10 to 20 minutes

semi fowlers

positioon of mother when undergoing contraction stress test

F

T or F: the adverse effect of oxytocin is that it ↑BP

negative cst

negative or positive cst?

• no late decelerations

• 3 contractions every 10 minutes

• fetus would probably survive labor if it occurred w/in 1 week

• action: OK FOR NOW

positive cst

negative or positive cst?

• persistent and consistent late decelerations with more than half of contractions

• action: EMERGENCY CS

biophysical profile

• combines data from 2 sources:

  • real time ultrasound imaging = measures amniotic fluid volume (AFV) and fetal mvmt

  • FHR monitoring

<4

fetal distress is ? kicks

reactive

normal result for non stress test

negative

normal result for contraction stress test

0

biophysical profile score if it has amniotic fluid volume of <5 cm