Answer Key For Exam
Answer Key For Exam
Answer Key For Exam
Insulin therapy:
• Many women with GDM will require insulin during pregnancy to maintain
adequate blood glucose levels despite compliance with the prescribed diet.
• Glibenclamide and metformin have been found to be effective and safe.
They crosses placenta but does not have any teratogenic effects.
• Insulin therapy is accepted medical management of pregnant women with
GDM not controlled on medical nutrition therapy in 2 weeks.
• Insulin to be administered subcutaneously using insulin syringe (40 IU) on
the lateral aspect of the thigh, anterior abdominal wall
• Elective delivery (induction or cesarean section ) is considered in patients
requiring insulin or with complications (macrosomia) at around 38 weeks.
Intra-partum management
• During the labor and birth process, blood glucose levels are monitored at
least every 2 hours to maintain the level at 100 mg/dl or less.
• IV fluids containing glucose are not given as a bolus.
• Blood glucose level and hydration must be carefully controlled during
labour.
• An IV line is inserted for infusion and maintenance of fluid such as R/L or
5% dextrose.
• Insulin may be administered by continous infusion or intermittent
subcutaneous injection.
• During 2nd stage of labor, shoulder dystocia may occur if delivery of
macrosomia infant is attempted.
• If C/S is planned it should be schedule in the early morning to facilitate
glycemic control.
• The morning dose of insulin should be with hold and the women is given
nothing by mouth.
• Epidural anesthesia is recommended because hypoglycemia can be detected
earlier if the women is awake.
• After surgery glucose level should be closely monitored at least every 2hrs.
Post-partum care
• More than 90% of the women with GDM will return to normal glucose
levels after child birth.
• Assessment for carbohydrate intolerance can be initiated 4-6 weeks
postpartum or after breast feeding has stopped.
• Mothers are encouraged to breastfeed as breastfeeding has an anti-diabetic
effect.
• Women who breastfeed should have additional 500 kcal daily in diet.
• In lactating women insulin dose is lower.
Care of the baby
• A neonatologist should be present at the time of delivery.
• The baby should be kept in intensive neonatal unit and to remain vigilant for
at least 48 hrs.
• All babies should have blood glucose to be checked within 2 hours of birth
to avoid problems of hyperglycemia.
• All babies should receive 1mg vitamin k intramuscularly.
• Early breastfeeding within half to 1 hour is initiated and repeated at 3-4
hours interval to minimize hypoglycemia and hyperbilirubinemia.
1. Anemia in pregnancy
Definition
Center for Disease Control (1990) has defined anemia as less than 11gm/dl
in the first and third trimesters and less than 10.5gm/dl in the second
trimester.
The qualitative definition of anemia is decreased oxygen carrying capacity
of the blood due to decrease in number of RBCs or hemoglobin or both.
A. Nutritional anemia
-Iron deficiency anemia
Iron is an essential constituent of the body, being necessary for formation of
hemoglobin
Signs and symptoms:
-Fatigue
-Anorexia and indigestion
-Lassitude
-Dyspnea
-Nausea and vomiting
-Pallor of mucous membrane
Investigation
-History taking
- Physical examination
-Blood investigations(CBC,RBC, ESR,PCB)
-Liver function test
-Renal function test
Treatment
-It includes:
a. Oral iron therapy
b. Parenteral iron therapy
c. Blood transfusion
a. Oral iron therapy
Preparation: ferrous form gluconate, fumarate, succinate but best absorbed in
ferrous form and ferrous sulphate 200 mg is given.
b.Parenteral Iron Therapy
2. Polyhydramnios
Definition
Polyhydramnios is defined as a state where liqor amnii exceeds 2000 ml.
• Sonographic diagnosis is made when amniotic fluid index (AFI) is more than
24cm (more than 95 percentile for gestational age) and a deepest vertical
pocket(DVP) is more than 8cm.
Etiology
Fetal Anomalies
• Anencephaly
• Open spinal bifida
• Esophageal or duodenal atresia
• Facial Clefts and neck masses
Maternal
• Diabetes
• Cardiac or renal disease
• Multiple pregnancy
• Idiopathic (50-60%)
Clinical types
Depending upon the rapidity of onset, it may be :
a. Acute (very rare types)
b. Chronic(common)
Chronic polyhydramnios
In majority of cases, the accumulation of liquor is gradual and the patient is not
very much inconvenienced.
Symptoms
• Respiratory: The patient may suffer from dyspnea or even remain in the
sitting positon for easier breath.
Investigation
• Sonography
• Blood
• Amniotic fluid is assessed to detect polyhydramnios.
Treatment
A. Mild degree hydramnios
• Amniocentesis
This procedure may need to be repeated.
If the pregnancy is less than 37weeks
• Done to relieve maternal mechanical distress.
• Amniotic fluid can be tested for fetal lungs, maturity.
• Slow decompression is done at the rate of about 500ml per hour.
If pregnancy more than 37 weeks
Induction of labor is done.
Intervention
• Provision of ARV drugs to mother infant
*TDF=Tenofovir
3TC=Lamivudine
FTC=Emtricitabine
EFVAZT=Efavirenz and Zidovudine
NVP=Nevirapine
• Modified safer obstetric practice i.e Elective Cesarean section
• Referral to comprehensive treatment care and social support for mother and
families with HIV infection.