OB test 2 set 3

Card Set Information

Author:
kbryant86
ID:
249077
Filename:
OB test 2 set 3
Updated:
2013-11-26 09:18:46
Tags:
OB Diabetes lecture
Folders:

Description:
OB 2
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user kbryant86 on FreezingBlue Flashcards. What would you like to do?


  1. diabetes mellitus vs

    gestational diabetes
     --> primary cause
    dm= impaired insukin production and/or inadequate insulin action in target tissue

    • gd= carbohydrate intolerance of any degree that developes or is first recognized during prego
    •  
    • --> the effect of prego hormones on carbs metab. and inability to compensate for these changes
  2. estrogen and progesterone changes on Carb metab. during 1st trimester
    • inc insulin production
    • inc tissue response to insulin
  3. results of estro and progest changes in 1st trimester
    • lower levels of fasting glucose levels
    • risk for hypoglycemic episodes
    • pre-existing diabetes on insulin may require LESS insulin at this time

    **NO gest diabetes during the 1st tri, if they have it here then it was already established
  4. estrogen and progesterone changes on Carb metab. during 2nd and 3rd trimester
    • inc insulin production
    • inc insulin resistance
  5. results of estro and progest changes in 2nd and 3rd trimesters
    • women are at risk for Hyperinsulemia and Hyperglycemia
    • pre-existing diabetes needing insulin may require MORE insulin at this time

    could possibly be gestational
  6. after placenta is delivered, hormone levels and insulin sensitivity return to normal

    women with GDM rarely need insulin meds

    "  "  pre-existing DM return to sliding scale
    after placenta is delivered, hormone levels and insulin sensitivity return to normal

    women with GDM rarely need insulin meds"  "

    pre-existing DM return to sliding scale
  7. maternal risk factors for developing GD
    • fetal macrosoma
    • polyhydramnios
    • relative with diabetes
    • unexplained fetal death/stillbirth
    • OTHER MORE OBVIOUS ANSWERS
  8. maternal complications
    • spontanious miscarriage
    • hydramnios
    • HTN disorders
    • hyperglycemia --> ketpacidosis
    • infections
  9. baby complications
    • teratogenic birth defects
    • LGA
    • IUGR or SGA
    • hypoglycemia 2-4 hours after birth
    • resp. distress synd
    • polycythemia
    • hyperbilirubimia
  10. what test is done to screen women with pre-existing diabetes?
    Hg A1c
  11. When do we test for GD?
    24-28 weeks
  12. 1hr (50g) oral glucose tolerance test
    SCREENING test

    • negative= good
    • positive= > 140 bad
    •  = move onto dx testing
  13. 3hr (100g) oral glucose tolerance test
    DIAGNOSTIC test

    • neg= no GD
    • positive if 2 or more levels are met

    • fasting > 95mg/dl
    • 1 hr > 180
    • 2 hr > 153
    • 3 hr > 140
  14. 2 goals of GD management
    maintain euglycemia throughout prego, labor, and delivery

    ensure health and safety of mom and baby
  15. dystocia

    factors:
    long, difficult, or abnormal labor caused by conditions associate with these 5 factors:

    • dysfunctional labor
    • alterations in pelvic structure
    • maternal position
    • psychological response of mother to labor
    • fetal cause: anomalies, LGA, malposition
  16. what is done for shoulder dystocia?
    the mcroberts maneuver and suprapubic pressure is applied

    break clavicle if needed
  17. encourage diabetic mothers to breastfeed and frequently to decrease the risk of diabetes in the baby

    watch for signs of hypoglycemia in baby hours after birth
    encourage diabetic mothers to breastfeed and frequently to decrease the risk of diabetes in the baby

    watch for signs of hypoglycemia in baby hours after birth
  18. what is the most common complication or prego?
    HTN disorders
  19. risk factors for HTN disorders
    • teens or >35 yrs
    • primiparas
    • black or native am.
    • Hx of preeclampsia
    • obesity
    • pre-existing disease
    • multi-fetal prego
    • renal transplant pt.
  20. Chronic HTN
    140/90 before 20 wks gest
  21. Pregnancy Induced HTN (PIH)
    • onset of HTN after 20 wks gest
    • can be present up to 5 days post-partum
  22. types of PIH
    • pre-eclampsia
    • eclampsia
    • HELLP syndrome
    • gest HTN
    • chronic w/ pre-eclamp
  23. nl lab values:

    platelets
    H&H
    ALT
    AST
    • platelets = 150/450 x 103
    • H&H = 33/11
    • ALT = <40
    • AST = <40
  24. Gestational HTN
    • transient elevation of BP W/O proteinuria and present after 20 wks
    • BP returns to nl by 12 wks after, and if not then it is chronic HTN
  25. management of gest HTN
    • pt monitors at home
    • frequent prenatal appointments
    • NST's (non-stress tests)
  26. pre-eclampsia

    mild pre-eclamp
    presents after 20 wks gest

    • mild:
    • BP >140/90 BUT <160/110
    • +2 proteinuria
    • can manage at home
  27. manage of mild pre-eclamp
    • urine dipsticks
    • BP monitoring
    • fetal movement counts
    • adequate fluid intake
  28. severe pre-eclamp
    • BP >160/110
    • +3-4 proteinuria
    • oliguria
    • cerebral or visual disturbances
    • epigastric pain
    • low platelets
    • PE's
    • hyperreflexia

    need hospitalized
  29. management of sever pre-eclamp
    • bed rest
    • monitor reflexes, edema, lungs, weight, fetus and contractions, labs
    • give corticosteroids, mag sulfate, anti-HTN
  30. Mag Sulfate route and reason
    given IV as a CNS depressant to prevent or control convulsions

    relaxes smooth muscles including uterus
  31. Mag sulfate loading and matainance doses
    load= 4-6g over 20 minutes

    main= 1-3g per hour
  32. normal SE's of load and maintainance dose of Mag sufate
    load= warm feeling, swelling, dry mouth, N/N, drowsiness, blurred vision, HA

    main= Lethargy, sluggishness
  33. Mag sulfate toxicity and antidote
    • toxic= absent deep tendon reflexes
    • high Mg levels
    • etreme ms weakness
    • oliguria
    • sever HypoTN
    • bradyapnea
    • cardiac arrest

    antidote= Calcium Gluconate
  34. 2 drugs given to manage BP >160/110
    hydralazine 10mg dose

    Labetalol 20-40mg IV every 15 minutes
  35. eclamp is characterized by  (1-3)
    • HTN
    • proteinuria
    • inc CNS involcment (seizures)
  36. during eclamp seizure

    after seizure
    during: stay with pt, make sure breathing, turn on side to prevent choking

    • after: assess fetus and contractions and cervix dilation
    • placenta abruption
    • can give Mag sulfate and Diazepam

    schedule Emergency c-section
  37. HELLP syndrome
    • Hemolysis = decreased H/H (33/11)
    • Elevated Liver enzymes = AST and ALT
    • Low Platelets = 150-450 thous)
  38. what is done for HELLP?
    • delivery immediately
    • pt. goes to ICU
    • monitor bp, reflexes, respers, etc.
  39. causes of preterm labor
    • infection
    • preterm premature rupture of membrane (PPROM)
    • dehydration
    • psychosocial factors
  40. PROM
    vs
    PPROM
    PROM= rupture at least 1 hr. before contractions begin after 37 wks

    PPROM= PROM 20-37 weeks of gest
  41. demographic risk factors for preterm labor
    • nonwhite race
    • age <15 or >45
    • low economic status
    • unmarried
    • <high school edu
  42. risk factors for preterm based on med hx
    • previous PTL
    • 2nd trimester miscarriage
    • many kids
    • progesterone deficiency
    • incompetent cervix
    • etc.
  43. clinical Dx of preterm labor
    • 20-37 weeks gest
    • Pt. having 4 contractions in 20 minutes OR 8 in one hour
    • Documented cervix change
  44. why are biochem tests used?
    to determine who needs and does not need tocolytics
  45. Fetal Fibronectin (fFN) test
    • large protein nly found b/w fetal membrane and uterine wall (biologic glue)
    • Glycoprotein can be in cervical canal @ 24-34 wks
    • Produced during fetal life
  46. - vs + fFN test
    • - = little chance of delivery w/n 7-10 days
    •   = no tocolytics needed

    • + = does NOT indicate that she will deliver soon
    •   = Pt. will receive tocolytic poer doc.
    •   = poor predictor of impending PT delivery
  47. Salivary Estriol test
    form of estrogen produced by fetus @ 9 weeks, found in plasma

    Collect saliva for estriol levels: done every 2 weeks for approx 10 wks
  48. interpret absent vs inc of Salivary Estriol
    • absent= indicates no labor
    •   = may decide to hold tocolytics

    • inc= does NOT reliably predict labor
    •   = additional assessments are used to determine tocolytic use
  49. short cervix can suggest preterm labor
    short cervix can suggest preterm labor
  50. when is a Cerclage placed on incomp. cervix?

    when is it removed?
    11-15 wks gest

    removed= 37 wks
  51. condraindications to tocolytic use
    • IU fetal death
    • fetal anomaly
    • term fetus
    • IUGR
    • pre/eclamp
    • active vag bleeding
    • chorioamnionitis
    • acute fetal distress
    • >4 cm dilation
  52. Terbutaline / Brethine
    • tocolytic
    • Beta-adrenergic agonist
    • relaxes smooth ms

    0.25mg q30min for 2 hours
  53. Mag sulfate
    tocolytic
  54. Nifedipine / Procardia
    • tocolytic
    • Ca block
    • relaxes smooth ms

    • 1st dose: 10-20mg PO
    • maintain: same, q4-6 hrs
  55. considerations for Procardia
    NEVER use with Mag sulfate
  56. Betamethasone / Celestone
    • Antenatal Glucocorticoid therapy
    • stimulates lung development for preterm infants born 24-34 wks

    12mg q24hrs IM twice

What would you like to do?

Home > Flashcards > Print Preview