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Sickle cell hemoglobinopathy is a recessive , hereditary , hemolytic anemia seen most often in what ethnic group?
______ _____ _____ is most often seen in African or Mediterranean ancestry.
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Discribe sickle cell trait.
A type of sickle cell hemoglobinopathy with only mild symptoms.
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Discribe sickle cell disease.
A type of sickle cell hemoglobinopathy with recurrent attacks of fever and pain in the abdomen or extremities starting form childhood.
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What causes the attacks in sickle cell disease?
Vascular occulusion, tissue hypoxia, edema and RBC destrution causes the attacks in ____ ____ ____..
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What are some maternal comlications with sickle cell hemoglobinopathy?(5)
- 1) UTI/pyelonephritis - common
- 2) Leg ulcers
- 3) Intense bone pain
- 3) Strokes
- 4) Cardiomyopathy/CHF
- 5) Preeclampsia
These are all maternal comlications with ______ _____ _______?
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What are some fetal comlications with sickle cell hemoglobinopathy?
- 1) IUGR
- 2) Small for gestational age
- 3) Skeletal changes
These are all fetal comlications with _______ ______ ______.
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What are some treatments for sickle cell hemoglobinopathy?
- 1) Morphine
- 2) Antihistamines
- 3) Blood transfusion
- 4) Prophylactic RBC transfusion
These are all treatments for ______ _____ _____.
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Discribe type 1 Diabetes Mellitus.(3)
- 1) Primarily caused by pancreatic islet beta cell destruction
- 2) Prone to ketoacidosis due to absolute insulin deficiency
- 3) Insulin is needed for cellular glucose uptake
These discribe what type of Diabetes Mellitus?
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Discribe type 2 Diabetes Mellitus.
- Characterized by insulin resistance usually relative (rather than absolute) insulin deficiency
- •Peripheral cell insulin resistance
- •Overproduction of hepatic glucose
- Beta cell defect leading to insufficient insulin
This is a discription of what type of Diabetes Mellitus?
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How does the placenta factor in with Diabetes Mellitus?
Glucose crosses the placentss - insulin does not.
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What happens to insulin need during the 1st trimester?
Insulin needs drop during the ____ trimester
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What happens to insulin need during the 2nd, 3rd trimester?
Insulin need steadily increase until about 36 weeks during the ___, ____ trimester
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What happens to insulin need postpartum.
_____ needs drop abruptly with expulsion of the placents.
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The fetus begins secreting insulin around __ weeks gestation.
The fetus begins secreting ____ around 10 weeks gestation.
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What are some maternal risks and complications with Diabetes Mellitus during pregnancy?(6)
- 1) Increased risk for miscarriage if poorly controlled glucose around time of conception
- •No increased risk if good glycemic control
- 2) Fetal macrosomia and sequelae
- 3) Preeclampsia
- 4) Polyhydramnios (excess amnionic fluid)
- 5) Ketoacidosis (if Type 1) – 2nd and 3rd trimester
- •Maternal stress may result in preterm delivery
- 6) Hypoglycemia
These are all maternal risks and complications with ______ ______ during pregnancy
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What are some fetal and neaonatal risk and complications associated with Diabetes Mellitus.(5)
- 1) Stillbirth (possibly because of chronic intrauterine hypoxia)
- 2) Congenital malformations (CV, CNS, skeleal system)
- 3) Macrosomia (large baby) and sequelae
- 4) Postpartum hypoglycemia
- 5) Delayed lung maturation
These are all fetal and neaonatal risk and complications associated with what disorder durng pregnansy?
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How does Diabetes Mellitus lead to postpartum hypoglycemia in neonates?
The baby is putting out lots of insulin to combat moms hyperglycemia. When they are born they are still producing high levels of insulin but the glucose input from mom is gone. These leads to what in neonates of mothers with Diabetes Mellitus.
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What are some interview explanations when you have a pregnant mom with Diabetes Mellitus.(3)
- 1) History of the disease
- 2) Related disorders
- 3) Complications (nephropathy,retinopathy, neuropathy, cardiovascular issues)
These are all things you should explain to the pregnant mom with _______ _____ during an interview.
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What's important to get during your interview with a pregnant mom with Diabetes Mellitus?
An accurate pregnancy date is important to get during your interview with a mom with _____ ______.
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Name some lab tests that should be done with a mom with DM.(4)
- 1) Hgb A1c (glycosylated hemoglobin)
- 2) Baseline renal function
- 3) UA/culture
- 3) Thyroid screen
- 4) EKG
These are all lab tests that should be done with a mom with ___ ___.
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What is the new test done instead of fasting blood sugar when doing labs on a mom with DM.
Hgb A1c (glycosylated hemoglobin) is the new test done instead of fasting blood sugar when doing labs on a mom with ___ ___.
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Your goal is euglycemia (normal concentrations of glucose) in DM management in pregnant women. What are the normal ranges for these three
1) Premeal/fasting
2) Postmeal (1 hour)
3) Postmeal (2 hour)
- 1) >65 but <105 mg/dl
- 2) <130-155
- 3) <130
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What is the plan of care for a mom with DM. (4)
- 1) Goal of euglycemia (normal concentrations of glucose)
- 2) Home blood glucose monitoring
- 3) Home urine testing for keytones
- 4) Exercise monitored closely to prevent complications like (hypoglycemia, and vasculopathy)
These are all done in the plan of care for a mom with what disorder?
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What medications are used in the treatment of DM in pregnant women? (3)
- 1) Insulin typicaly used (basal insulin, and mealtime bolus insulin)
- 2) Insulin pumps
- 3) Some oral antihyperglycemic agents now used.
These are used in the treatment of what in pregnant women?
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A baselin utrasound should be done for what reason in fetal surveillance of moms with DM?
A baselin utrasound should be done to confirm dates and viability in mothers with __ ___.
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This should be done in the weeks 16-18 of pregnancy in a mom with DM.
Serum AFP should be done in the weeks ___-___of pregnancy in a mom with DM.
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This should be done in the weeks 18-21 of pregnancy in a mom with DM.
A detailed utrasound should be done in the weeks __-__ of pregnancy in a mom with DM.
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This should be done in the weeks 20-22 of pregnancy in a mom with DM.
A fetal echocardiogram should be done in the weeks ___-___ of pregnancy in a mom with DM.
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This should be done in week 28+ of pregnancy in a mom with DM.
NSTs (Non stress test) should be done in week ____+ of pregnancy in a mom with DM.
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This should be done in the weeks 37-39 of pregnancy in a mom with DM.
Amniocetesis should be done in the weeks __-__ of pregnancy in a mom with DM.
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