Diabetes
Definition – chronic endocrine disease, after 20w
Why does it happen – hormones hpl, oestrogen etc inc insulin resistance,
carbohydrate/glucose intolerance role of beta cells – normal production of insulin
Risk factors – first degree, Previous gdm, multiple, age, bmi, pcos, ethnicity
History taking – risk factors, urinalysis – glucose in urine, +1 on 2 occasion or 2+
on one occasion refer to GTT
16 w prev GDM and another at 24-28 weeks, normal 24
Fasting blood test below 5.6 mmol - 75g of sugar, wait 2hrs – another fasting
glucose below 7.8
HBA1C – confirmed GDM – average blood glucose over 3months to rule out type2
– every 3 months in pregnancy, postnatally annually forever.
Signs/symptoms – generally asymptomatic, (hyperglycaemia) thirst, tiredness,
urination, loose weight
Impact on pregnant person – induction, future gdm, type 2, PET, birth trauma,
miscarriage & stillbirth, hyperemesis
Impact on baby – Sholder dystocia, LGA, Macrosomia, Hypoglycaemia (sugary
blood in to placenta baby producing more insulin, still producing insulin
postnatally so risk of hypoglycaemia), Premature, Fetal Hypoxia, IUGR,
polyhydramnios, inc risk of instrumental/section, respiratory distress syndrome,
neonate death/admission
Care plan – Colostrum harvesting, Diet/lifestyle choices, diabetic
midwife/obstetrician, serial growth scan, Hypo pathway for baby, Continuous
monitoring in labour
Pre-eclampsia
Definition – multi symptom disorder presenting after 20w characterised by new
onset hypertension, proteinuria and organ dysfunction.
In the placenta as a result of ischemia
2nd wave of trophoblast invasion, trophoblast fail to invade the spiral arteries
which means arteries don’t dilate causing vasoconstriction = reduced blood flow
to the placenta
disrupt epithelial cell integrity widespread activation of endothelial cells -
inflammatory factors
production of vasodilators are reduced, vasoconstrictors increased – generalised
vasoconstriction & reduced tissue Perfusion.
Risk factors – first degree family history, first pregnancy, with a new partner,
history of hypertension, bmi, age, multiple pregnancies, chronic
kidney/autoimmune disease,
, BP of 140/90, proteinuria – PCR, PET bloods – Full blood count, urea + electrolyte,
liver function, clotting, group and save
Frontal headaches, blurred vision, oedema (fluid leaking into tissues due to
damaged epithelial) protein urea (protein leaking from glomerular filter due to
damage of glomerular endothelial cells), epigastric pain (swelling of liver),
development into eclampsia – seizures, develop into HELP & DIC
Low platelet – intrapartum period – epidural, theatre, pph. Organ damage,
placental abruption, IOL
IUGR – SGA, Premature, Stillbirth, hypoxia, hypoglycaemia if on labetalol, high
risk of IUD, bradycardia
Care plan – consultant led care, Fetal growth scan, aspirin to stop before birth, BP
checks, CTG, induction if PET poorly control, hypo pathway, colostrum harvest,
mag sulph reduce risk of seizures, steroids if preterm birth
Station 2
Name – cross reference wristband, allergies cross-check red wristband, ask
patient. Hospital number and date of birth, Prescribers name and bleep num.
Name of medication and dose, route, frequency, signature, time, duration, expiry
date
Storage – should be locked cupboard at room temperature
Right
Hand Hygeiene – hand washing for infection control wearing gloves – dispense as
prescribed – check expiry date
Documentation – on prescription chart and maternal notes
Consider language needs, translator – consider religious and ethnic needs.
Explaining why medication is needed and what it does. Informed consent.
Labetalol
Combined alpha and beta blocker - causes blood vessels to dilate, slows down
the heart rate increasing blood flow reducing hypertension.
Oral or IV - 200mg up to 2400mg per day. BD
Contraindication – Asthma, Cardiovascular disease and Diabetes.
Side Effects - dizziness, headaches, shortness of breath
Safe for breastfeeding mothers
Metformin
Definition – chronic endocrine disease, after 20w
Why does it happen – hormones hpl, oestrogen etc inc insulin resistance,
carbohydrate/glucose intolerance role of beta cells – normal production of insulin
Risk factors – first degree, Previous gdm, multiple, age, bmi, pcos, ethnicity
History taking – risk factors, urinalysis – glucose in urine, +1 on 2 occasion or 2+
on one occasion refer to GTT
16 w prev GDM and another at 24-28 weeks, normal 24
Fasting blood test below 5.6 mmol - 75g of sugar, wait 2hrs – another fasting
glucose below 7.8
HBA1C – confirmed GDM – average blood glucose over 3months to rule out type2
– every 3 months in pregnancy, postnatally annually forever.
Signs/symptoms – generally asymptomatic, (hyperglycaemia) thirst, tiredness,
urination, loose weight
Impact on pregnant person – induction, future gdm, type 2, PET, birth trauma,
miscarriage & stillbirth, hyperemesis
Impact on baby – Sholder dystocia, LGA, Macrosomia, Hypoglycaemia (sugary
blood in to placenta baby producing more insulin, still producing insulin
postnatally so risk of hypoglycaemia), Premature, Fetal Hypoxia, IUGR,
polyhydramnios, inc risk of instrumental/section, respiratory distress syndrome,
neonate death/admission
Care plan – Colostrum harvesting, Diet/lifestyle choices, diabetic
midwife/obstetrician, serial growth scan, Hypo pathway for baby, Continuous
monitoring in labour
Pre-eclampsia
Definition – multi symptom disorder presenting after 20w characterised by new
onset hypertension, proteinuria and organ dysfunction.
In the placenta as a result of ischemia
2nd wave of trophoblast invasion, trophoblast fail to invade the spiral arteries
which means arteries don’t dilate causing vasoconstriction = reduced blood flow
to the placenta
disrupt epithelial cell integrity widespread activation of endothelial cells -
inflammatory factors
production of vasodilators are reduced, vasoconstrictors increased – generalised
vasoconstriction & reduced tissue Perfusion.
Risk factors – first degree family history, first pregnancy, with a new partner,
history of hypertension, bmi, age, multiple pregnancies, chronic
kidney/autoimmune disease,
, BP of 140/90, proteinuria – PCR, PET bloods – Full blood count, urea + electrolyte,
liver function, clotting, group and save
Frontal headaches, blurred vision, oedema (fluid leaking into tissues due to
damaged epithelial) protein urea (protein leaking from glomerular filter due to
damage of glomerular endothelial cells), epigastric pain (swelling of liver),
development into eclampsia – seizures, develop into HELP & DIC
Low platelet – intrapartum period – epidural, theatre, pph. Organ damage,
placental abruption, IOL
IUGR – SGA, Premature, Stillbirth, hypoxia, hypoglycaemia if on labetalol, high
risk of IUD, bradycardia
Care plan – consultant led care, Fetal growth scan, aspirin to stop before birth, BP
checks, CTG, induction if PET poorly control, hypo pathway, colostrum harvest,
mag sulph reduce risk of seizures, steroids if preterm birth
Station 2
Name – cross reference wristband, allergies cross-check red wristband, ask
patient. Hospital number and date of birth, Prescribers name and bleep num.
Name of medication and dose, route, frequency, signature, time, duration, expiry
date
Storage – should be locked cupboard at room temperature
Right
Hand Hygeiene – hand washing for infection control wearing gloves – dispense as
prescribed – check expiry date
Documentation – on prescription chart and maternal notes
Consider language needs, translator – consider religious and ethnic needs.
Explaining why medication is needed and what it does. Informed consent.
Labetalol
Combined alpha and beta blocker - causes blood vessels to dilate, slows down
the heart rate increasing blood flow reducing hypertension.
Oral or IV - 200mg up to 2400mg per day. BD
Contraindication – Asthma, Cardiovascular disease and Diabetes.
Side Effects - dizziness, headaches, shortness of breath
Safe for breastfeeding mothers
Metformin
