OB Exam #4: Pregnancy at Risk I Pre-Gestational Onset

As a review of metabolism, what is produced by beta cells in the pancreas?
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what type of metabolism during pregnancy does estrogen, and progesterone stimulate birthing person's insulin production and increase the tissue response and builds up glycogen stores in the liver and other tissues?anabolicwhat type of metabolism during pregnancy involves Human placental lactogen (hPL) and prolactin which increases peripheral resistance to insulin and ensures glucose for the fetus and requires the birthing person to produce more insulin to meet her needs and post-prandial (after meals) hyperglycemia and hyperinsulemia is evident (need to boost insulin before baby gets it since competing for glucose)?catabolicwhat two hormones increases peripheral resistance to insulin and ensures glucose for the fetus and requires the birthing person to produce more insulin to meet her needs during the catholic phase of pregnancy?Human placental lactogen (hPL) and prolactinwhat two hormones stimulate birthing person's insulin production and increase the tissue response and builds up glycogen stores in the liver and other tissues?estrogen and progesteroneduring what half of pregnancy is the body preparing for growth, builds stores (glycogen), and stores a lot more power to get the baby to grow?first half - anabolicduring what half of pregnancy is the body cashing in the glycogen stores, is harder for the birthing person to rapidly grow their own cells, prioritizes the baby's needs over the mother, harder for mom to use her own cells and meet glucose needs, and needs to make more insulin?second half - catabolicduring the catabolic phase of pregnancy, if the mother cannot meet the demands of increased insulin production for her own body, what happens to the mother when she cannot make enough insulin while making more sugar for the baby?gestational diabeteswhat is essential for the type 1 and type 2 diabetes mellitus population?preconception counselingphysiologic changes alter what requirements since during the first half of pregnancy which is an anabolic state, these requirements/needs are decreased in the first trimester but in the second half of pregnancy which is the catabolic state, the needs increased by 2x to 4x by the end of the pregnancy?insulinwith preconception counseling, what needs to be controlled so that the patient is the healthiest version of herself before conceiving (helps with early sugar regulation and need a lot of help to cure the issues caused by this)?diabetes mellituswhat hormone is an insulin antagonist and with DM it is more difficult to control in pregnancy and there are worsening complications (e.g. retinopathy)?Human Placental Lactogen (hPL)what type of injections for diabetes mellitus patients may need to be decreased due to hormonal influences that happens not heir own?insulinbecause healthcare is a team approach, who will be managing the patients DM (Diabetes Mellitus) during pregnancy?endocrinologists not the OB teampreeclampsia/eclampsia (HTN), hyperglycemia and ketoacidosis, and increased susceptibility to infection are all results in the mother from what condition during pregnancy?diabetes mellitusperinatal mortality, congenital anomalies (control blood glucose levels) and hydramnios are all fetal complications of what condition of the mother?diabetes mellitusRDS, polycythemia (risk of hyperbilirubinemia), macrosomia/dystocia,a nd rebound hypoglycemia after birth are all fetal complications of what condition of the mother?diabetes mellituswhat crosses the placenta and what does not? A. glucose B. Insulininsulin does NOT cross the placenta (baby makes insulin) glucose DOES cross the placenta (mom give glucose)if the mother cannot increase enough insulin in order for her body to store glucose into her own tissues what may happen to the mother (glucose remains free in the blood)?ketoacidosiswhat is the worse case scenario for the fetus if the mother has poorly controlled diabetes (complication of DM)?perinatal mortalitywhich one of the complications of DM in the mother includes cardiac and skeletal being the most common categories and possibly neurological but overall the higher the sugar is the worse the problem will be?congenital anomalieswhich one of the complications of DM in the mother includes too much fluid in the amniotic sac which is mostly the baby's urine therefore the baby is experiencing polyuria due to high levels of sugar it is getting from the mother?hydramnioswhich one of the complications of DM in the mother includes being the hardest to understand, baby is potentially making too much insulin in response to high levels of sugar coming through and insulin is a surfactant antagonist and so high levels of insulin for prolonged time results in lungs having hard time to function when they come out and making it harder for surfactant to do its job; babies have to work harder so babies come out bigger and more delicate?respiratory distress syndromewhich one of the complications of DM in the mother includes placenta not being well perfused for the duration of the pregnancy so the baby compensates by making extra RBCs to carry enough O2 since they don't get enough from the mom and is at risk for hyperbilirubinemia after delivery but in utero they are usually fine?polycythemiawhich one of the complications of DM in the mother includes babies being so used to high levels of sugar that when their high level of supply gets cut off they immediately rebound?rebound hypoglycemiawhich one of the complications of DM in the mother includes babies eating a lot and growing fast?macrosomia/dystociawhen screening for pre-gestational DM (Type I or II - already diagnosed), the target for HbA1C Glycosolated hemoglobin is less than how many %?<7%If the patient has up to a 10% A1C screen then what is the risk of the baby having anomalies in %?25%the risk factors for what condition are family Hx, prior macrosomia/anomaly, obesity, >25 y/o, and ethnic/racial group with high prevalence (non-white) which require to be screened at the first prenatal visit?Diabetes mellituseveryone is screened for diabetes at how many weeks to how many weeks GA?24-28 weeksthe methods for screening what condition includes giving the patient a jar of sugary soda, drawing blood an hour later and expecting the body to handle a certain level of sugar to see how that known amount of sugar is processed by the body?Gestational Diabeteswhen screening for DM, how many gm of glucose is in the 1-hour test?50 gmwhen screening for DM, how many gm of glucose is in the 3-hour test (drawing blood three times) after failing the 1-hour test?50 gmwhen screening for DM, how many gm of glucose is in the 2-hour test?75 gmwhat is known as the glucose intolerance with its onset during pregnancy or first detected during pregnancy (diabetic just within the confines of pregnancy) (temporary - first detected during pregnancy)?gestational GDMIn white's classification of GDM (extent of the disease), which type of GDM is mild glucose intolerance and can be controlled with diet and exercise?A1 GDMIn white's classification of GDM (extent of the disease), which type of GDM may need medication and insulin to control it?A2 GDMwhat type of GDM is dietary and exercise management only?A1 GDMwhat type of GDM is insulin management and oral hypoglycemic management?A2 GDMwhat type of GDM includes a finger stick glucose, Q1 hour glucose checks in labor, NB at risk for hypoglycemia and BF encouraged?A1 & A2 GDMwhat condition antepartum is managed when doing an AFP quadruple screen, fetal activity monitoring, NST at about 28 weeks, biophysical profile and frequent ultrasound for the fetus?Diabetes mellitusfor what condition is glucose monitoring essential for the mother and counseling is needed for the risk of progression?diabetes mellitusmedical therapy for A2 GDM includes oral hypoglycemic which is what type of medication?metformin (or glyburide)In antepartum DM management if what medication is not tolerated then an oral hypoglycemic is given instead which is usually metformin?insulinIn antepartum DM management, what medication is preferred for A2 GDM and with it intolerance is not very popular and so it requires a lot of teaching due to needle injection and if patient is allowed to do it and tolerate it then she will have better outcomes?insulinduring what antepartum management for the mother must be emphasized that DM is a burden to the body and if the body cannot meet the increased demand then we must prevent progression to type II and identify pre-diabetic since it is important to get good habit in place RIGHT NOW before conception?preconception counselingat about how many weeks are NST's done for high risk patients for DM?28 weekswhat fetal test is done to monitor kick counts in a pregnant mother who has DM?fetal activity monitoringwhat fetal text is done to monitor growth levels of the fetus in a pregnant mother who has DM?biophysical profileWhat intrapartum management of DM includes the timing of birth and is possibly done at 39 weeks if the lungs are mature assuming they have not gone into spontaneous labor yet at this point?Induction of Laborwhat procedure would be possible ti identify if fetal lungs are mature during the timing of birth in an intrapartum management of DM setting?amniocentesiswhat type of intrapartum management of DM includes Q1 hour glucose checks (goal being 70-110 mg/dL), and IV management?Labor managementFor intrapartum management of DM what is the goal for the birthing person which includes preventing rebound hypoglycemia of the NB, bringing down the overall availability of sugar so that a certain amount of sugar is left for baby to make a controlled amount of insulin so that when cord is cut then there is not much of a difference when they are not getting sugar from the mother?prenatal and intrapartum euglycemiaFor postpartum management of DM, birthing person's insulin requirements drop after what stage of labor (reverts back to normal body function VERY quickly)?the 3rd stage of laborduring what phase of labor management of DM includes diabetic control and bonding, close assessment of NB transition and watching CLOSELY for signs of hypoglycemia (may have macrocosmic look to them but are delicate) and BF is encouraged (sugar better absorbed in baby)?postpartum managementduring what phase of labor management of DM includes glucose monitoring being essential for the mother and Quadruple AFP screen, fetal activity monitoring, weekly non-stress testing (NST), biphysical profile and frequent US?antepartumFor anemia in pregnancy, insufficient hemoglobin production would be classified as an Hgb of what while pregnant (g/dl)?<11 g/dlthe causes of what in pregnancy are iron deficiency (pica consequence of this) and hemoglobin destruction disorders (sickle cell or thalassemia which are not very common)?anemiawhat deficiency is the most common pregnancy complication and is the greatest in the second half of the pregnancy?iron deficiencyIn iron deficiency, if you see what present then you must draw hemoglobin levels?picawhat is the standard dose of iron for pregnant women?27 mgthe maternal complications of what condition includes susceptible to infection, fatigue, delayed healing, and blood loss during birth is poorly tolerated?anemia in pregnancythe fetal complications of what condition includes low birth weight, prematurity, and stillbirth?anemia in pregnancythe prevention of anemia includes at least how many mg of iron daily (PNV) (consistent dosing)?27 mgthe treatment of anemia includes how many mg (range) of iron daily and you must tell the patient that large doses can cause GI symptoms and parenteral administration PRN in severe cases?60-120 mgimportance of iron-rich diet (supplements), taking iron tablets before meals with vitamin C (orange juice is acidic NOT milk) (in a perfect world it would be taken on an empty stomach - with meal will be recommended to avoid GI upset), stool will turn black (constipation is common), and out of reach of children are all included in what portion for clinical therapy of anemia in pregnancy?educationwhat can occur at any time during pregnancy, and most likely can cause harm in the first trimester due to organ development and later on in the pregnancy can cause growth restriction and neurologic disturbances?fetal infectionIn what trimester does organ development occur for the fetus and fetal infection during this time would be detrimental to the fetus?first trimesterwhat is a mild illness in children, and adults but is severe for the fetus (biggest risk and can cause miscarriages)?rubellathe fetal-neonatal risks of what are first trimester being the greatest risk, congenital cataracts, hearing/intellectual disability, congenital heart defects (nasty infection if patient gets this early), microcephaly, and congenital syndrome (need to be isolated from other babies b/c very contagious)?rubellawhat is known as a smaller head for babies?microcephalyrubella has the greatest risk for the fetus in what trimester?first trimesterthe best therapy for what illness is prevention, it is important to test all pregnant individuals for this immunity (titer), and if a vaccine is needed the live attenuated virus is not given during pregnancy (patient is watched closely throughout pregnancy) and only administered postpartum PRN?rubellawhat kind of vaccine is the rubella vaccine?live attenuatedGroup B Streptococcus is also known as what three things?GBS, Beta strep, and GBBSwhat condition of the mother is in the lower GI and urogenital tracts and maternal morbidity includes pyelonephritis, chorioamnionitis, and sepsis?GBSwhat condition of the mother is part of the normal flora of the mother, is not an STI, not due to poor hygiene,, and only becomes a problem when it is in the body and attacks the baby since they can get very sick from it (can result from a pyelonephritis of the mom and gets into places it should not and if we don't catch it then worse outcome for mom and baby)?GBSrisk factors for neonates developing what condition include prematurity (more likely to get complications), prolonged ROM > 18 hours, previous infant with this disease (sibling) and maternal infection and baby is vulnerable?GBS sepsisother complications of what condition of the mother include intrapartum stillbirth, respiratory distress, pneumonia, and meningitis?GBS diseasescreening for GBS is done at around what range of weeks GA and includes a vaginal rectal swab, and also treat if GBS is in the urine or prior newborn infection?35-37 weekswhat is needed for GBS at onset of labor or SROM that is included in clinical therapy for GBS and is done Q4 hours until vaginal delivery but no treatment is necessary if delivery by C/S (not going through the birth canal so baby does not come into contact with GBS)?Ampicillin/Antibioticswhat is the infection of the amniotic fluid, membranes, and/or placenta - may become a blood infection, potential for maternal or neonatal sepsis?chorioamnionitiswhat condition is caused by the normal flora (e.g. E coli, GBS) or introduction of bacteria of the mother and is at risk with prolonged ROM and is diagnosed with a fever > 100.4 F (more active metabolic state), tachycardia (maternal and fetal possible), tender uterus (push on belly and it hurts so much because of inflammation in the tissue), and foul odor?Chorioamnionitiswhat is treated with antibiotics and is typically ampicillin and gentamicin; prophylactic treatment to prevent them from getting sick from GBS and is now being used for an active infection?chorioamnionitiswhat may eventually become sepsis of the mother if it gets into her blood stream, the common route is ascending from the vagina, the longer the bag is ruptured the higher the risk is for this?chorioamnionitiswhat is more likely a severe illness in pregnancy vs. non-pregnant persons and changes the immune system (not good at fighting infection during this time - adaptive immunity is suppressed and innate is enhanced - must protect the mother from this at all costs), heart and lungs -> highly contagious?influenzawhat vaccine is highly encouraged in pregnancy and is a shot (inactive) given in any trimester and the nasal spray version if contraindicated because it is live attenuated - must decrease the severity?influenzawhat is the treatment for influenza in pregnant patients?antiviral medicationswhat perinatal infection is a viral causative agent, no FSE/IUPC (contraindications), majority of exposure risk at delivery, and newborn gets prophylactic treatment?hepatitis B and HIVwhat perinatal infection is transmitted in breast milk and an AZT is used for treatment of the NB?HIVwhat perinatal infection is prevented with a vaccine, safety to breast feed with it and immune booster is given (HBlg)?Hepatitis Bwhat perinatal infection is contracted by 12 million people in the US and 2 billion worldwide (uncommon unless you have a very high load)?Hepatitis Bwhat perinatal infection is transmitted through blood, semen, bodily fluids and the theory of perinatal transmission is that it can cross the placenta, but delivery is majority of the exposure?hepatitis Ba prenatal screening panel is used to detect what surface antigen in a patient who is hepatitis B positive?HBsAGfor what perinatal infection should the exposure be limited by no AROM or internal monitors (FSE/IUPC) if the mother is positive?Hepatitis Bfor what perinatal infection is NB prophylaxis treatment within 12 hours of birth (series of 2 shots but three shots by the time they get discharged) and a vaccine and immune globulin (extra antibodies) is given and it is safe to breastfeed (virus does not transmit this way) once the baby is born?hepatitis Bover 1.2 million people are living with what perinatal infection int he US and is found in blood, semen, vaginal fluid and breast milk?HIV/AIDSfor what perinatal infection is staging done by CD4 and T-lymphocyte counts and success of routine aggressive perinatal care and being on top of ART (Antiretroviral therapy), can reduce the load meaning reduced risk fo transmission to the baby and better outcomes of pregnancy?HIV/AIDSfor what perinatal infection is transmission starting to decline because since mid-1990s, 90% decline in perinatal infections and with treatment there was 1% transmission but it is not always the case since there are still disparities between resource-rich and poor countries who don't have resources?HIV/AIDSclinical therapy for what perinatal infection includes ART for all infected pregnant individuals, evaluate and treat for other conditions (signs of infection) and STIs (prenatal panel at first prenatal check) and assess regularly for serologic changes and early signs of complications since poor healing then at risk for more infection?HIV/AIDSclinical therapy for what perinatal infection includes majority of exposure being during labor and birth, scheduled C/S birth for viral load of >1000 copies/mL, and vaginal birth preferred if <1000 copies/mL but with no AROM or internal monitors (FSE/IUPC), and IV AZT until cord clamp (must be very patient with these mothers)?HIV/AIDSfor HIV/AIDS, we try and decrease the time + exposure factor since we want a viral load under what for a vaginal birth and a viral load above this for a CAREFUL C/S If needed but ideally we sat to keep viral count low for a vaginal since a vaginal is more preferred than a C/S with these patients?1000 copies/mLfor what perinatal infection is breastfeeding contraindicated in the USA and is better to use formula but it is not the case for the worldwide?HIV/AIDSwhat treatment is started right away for mothers with HIV/AIDS and is started on the baby within 12 hours of life, 2 mg/kg PO Q6 hours, X6 weeks and discharged with 6-week regimen of oral use?prophylactic AZTfor prophylactic AZT for mothers with HIV/AIDS, how many mg/kg does the baby get? Q how many hours? for how long?- 2 mg/kg - Q6 hours - 6 weeksprophylactic AZT makes sure what perinatal infection does not progress (best coverage possible, must take medications throughout, great prenatal care needed), we must test infants for known exposure before treatment, progression of this in infants is associated with severe immunosuppression and prognosis remains poor?HIV/AIDSIf mother is HIV positive and she did not prenatal care what so ever and was given AZT throughout the labor process, the transmission rate is how many %? If mother had no AZT then what is the transmission rate in %?- 10% - 25%fo what perinatal infection is breastfeeding contraindicated, and when replacement feeding is affordable, safe, and sustainable, then use formula to avoid transmission but if not then breastfeeding should only be used the first 6 months?HIV/AIDS