OB

Diabetes in Pregnancy

  • Types of Diabetes Affecting Pregnancy

    • Type 1 Diabetes (T1D):

      • Patients usually on insulin and may require adjustments during pregnancy.

      • Monitor for potential need for insulin during labor.

    • Gestational Diabetes:

      • Occurs after 20 weeks of pregnancy.

      • May cause complications such as shoulder dystocia (enlarged baby), where no proteinuria is present, and blood pressure normalizes by 12 weeks postpartum.

Hypertension in Pregnancy

  • Chronic Hypertension:

    • Present before 20 weeks, requiring blood pressure monitoring and medication management such as labetalol and nifedipine.

  • Gestational Hypertension:

    • New onset hypertension after 20 weeks, with complicating risks such as pre-eclampsia characterized by proteinuria with multi-system symptoms.

    • Conditions include ketoacidosis, premature membrane rupture, and various systemic complications (epigastric pain, neurologic symptoms, etc.).

Pre-eclampsia and Preeclampsia Management

  • Defined as hypertension and proteinuria after 20 weeks.

  • Symptoms:

    • Headaches, visual changes, abdominal pain, high blood pressure.

  • Management:

    • Control blood pressure and prevent seizures using magnesium sulfate.

    • Monitor for signs of complications: respiratory depression, reflect slow contractions (more than 6 contractions/hour).

    • For severe features, use steroids to mature fetal lungs (betamethasone).

Intervention Measures

  • Magnesium Sulfate for seizure prevention.

  • Terbutaline: Inhibits contractions.

  • Nifedipine: Smooth muscle relaxant.

  • Betamethasone: To mature baby’s lungs.

  • Ca gluconate: Antidote for magnesium toxicity.

Labor and Delivery Considerations

  • Be aware of complications during labor: contractions duration, excessive pressure, meconium-stained fluid, fetal heart rate changes, etc.

  • Shoulder Dystocia:

    • Defined as the inability of the fetal shoulders to pass through the pelvic brim.

    • Treatment includes McRoberts maneuver and suprapubic pressure.

Placental Issues in Pregnancy

  • Placenta Previa:

    • Keep abdominal palpations gentle; avoid vaginal examinations if painless bright red bleeding is present.

  • Placental Abruption:

    • Characterized by sudden, intense pain, late preterm (before 37 weeks), and can lead to C-sections.

  • Postpartum Hemorrhage:

    • Defined as blood loss greater than 1000 mL; manage through fundal massages and fluid support.

Neonatal Considerations

  • Neonatal Sepsis:

    • Monitor for fever, mottled skin, hypoglycemia, and poor feeding.

    • Group B Streptococcus-positive babies are more prone to sepsis; timely notifications to physicians are crucial.

  • Risk Factors for Infection include UTIs, bacterial vaginosis, etc.

  • Infections of Concern:

    • TORCH infections: Toxoplasmosis, Other infections (syphilis, varicella), Rubella, Cytomegalovirus, and Herpes Simplex Virus.

    • Prophylactic measures include vaginal exams for GBS, with follow-up testing and antibiotics during labor.