Gestational Diabetes Mellitus (GDM) - Answers the mother can usually handle her blood sugar needs on
own but when she becomes pregnant - the pancreas may not be able to keep up with her needs and the
fetus's needs
What is a major complication for the fetus that results from GDM? - Answers Macrosomia - the fetus
grows too big leading to complications
Diagnosis of GDM - Answers Glucose Tolerance test (GTT) at about 25-27 wks. gestation: 1hr & 3hr tests
· 1 hr test
o No fasting
o 130-140mg/dL or = more testing needed (3hr test)
o Under 130 mg/dL = normal no additional testing needed
· 3 hr test
o Require fasting
o No caffeine or smoking
o Glucose will be tested at 1 hr, 2 hrs., and 3 hrs.
treatment for GDM - Answers Insulin
Diet control
Can a pregnant woman have oral anti diabetics? - Answers no
most are contraindicated during pregnancy
Pre-eclampsia - Answers increased BP and proteinuria (+1)
with pre-eclampsia assessment: - Answers headache
blurred vision
hyperreflexia
edema
epigastric pain
eclampsia - Answers Severe preeclampsia symptoms with seizure activity or coma
eclampsia is usually preceded by - Answers headache
,severe epigastric pain
hyperreflexia
hemoconcentration
HELLP syndrome - Answers hemolysis, elevated liver enzymes, low platelets
Treatment for pre-eclampsia - Answers -Bed rest, vitals Q1hr, listen to lungs, I&O, DTR
-Administer magnesium sulfate [Antidote- calcium gluconate]
-hydralazine
-methydopa
-nifedipine
Can you give ACE inhibitors or ARBs to pregnant women with pre-eclampsia? - Answers no
contraindicated
signs of magnesium sulfate toxicity - Answers Absent DTRs,
RR <14,
decreased LOC,
severe hypotension muscle relaxation,
urine output of <30 ml/hr
#1 cause of preterm labor - Answers infections
Oxytocin (Pitocin) - nursing management - Answers - monitor BP & pulse
- hypertonicity of uterus
- FHR
When should you stop an oxytocin infusion? - Answers -fetal bradycardia and late or variable
decelerations
-contractions less then q 2 minutes
-duration longer than 90 seconds
what should you do if you noticed adverse effect's with oxytocin? - Answers STOP
S - Stop infusion
, T - Turn on left side
O - O2 admin
P - Provider should be called
cervical ripening - Answers the process of softening and thinning the cervix by artificial means
Contraindications for cervical ripening - Answers - Non-reassuring FHR
- previous c-section
- placenta previa
- undiagnosed vaginal bleeding
- not wanting vaginal worth
mechanical ripening - Answers inserting a foley and then inflating the ballon
Misoprostol (Cytotec) - Answers ripening agent
can be given PO/vaginally/rectally
Cervidil (Dinoprostone) - Answers Vaginal insert with string. Placed near the cervix and removed 12
hours after insertion. Contraindication: previous c-section or uterine scar.
VEAL CHOP - Answers V- Variable C- Cord Comphression
E- Early Decels H- Head Compression
A- Accelerations O - OK
L-Late Decels P - Placenta Insufficiency
FHR variability - Answers The fluctuations in the FHR baseline that are irregular in amplitude and
frequency (GOOD)
Accerlerations of FHR - Answers visually apparent abrupt increase in FHR
indicates = GOOD viable baby
Decelerations in FHR - Answers Periodic decrease in FHR
FHR tachycardia - Answers a rise in the baseline FHR about 160 bpm for at lease 10 minutes
Causes of FHR Tachycardia = - Answers 1. Maternal hypotension
2. Umbilical cord prolapse