COMPLEXITIES IN MIDWIFERY EXAM QUESTIONS AND
DETAILED ANSWERS|ALREADY GRADED A
Where is insulin produced? Correct Ans- beta cells of islets of
Langerhans in pancreas
What is type 1 diabetes? Correct Ans- autoimmune condition which
attacks beta cels in the pancreas resulting in the inability to produce
insulin
What is type 2 diabetes? Correct Ans- cells are resistant to insulin
What is gestational diabetes? Correct Ans- hormones produced in
pregnancy cause glucose to rise and result in insulin resistance over time
What are the risk factors for diabetes? (12 things) Correct Ans- First
degree relative
Ethnicity (South Asian, Black African, Black Caribbean)
High BMI (>30)
Age
Previous GDM
Previous macrosomic baby (>4.5kg)
Previous fetal/neonatal loss
Previous fatal anomaly
Hypertension
Multiple Pregnancy
,IVF pregnancy
PCOS
what are the symptoms of diabetes? Correct Ans- Fatigue/lethargy
Thrush infections/gential itching
Polydipsia (excessive thirst)
Delayed Healing
Polyuria (increased volume of urine)
Headaches/blurred vision/dizzy spells
Glycosuria (sugar in urine)
Shakiness
Unexplained weight loss
Clamminess/sweaty
Autoimmune condition
Muscle Weakness
Convulsions/fainting
Irritability
Ketotic breath
Loss of sensation in extremities
Pre-conceptual midwifery care for women with diabetes Correct Ans-
Avoid unplanned pregnancy
MOT prior to stopping contraception (including retinal and renal
function)
,Monthly HbA1c (should be below 48mmol)
Increased folic acid (5mg)
increased appointments during pregnancy
incidence rate of each kind of diabetes during pregnancy Correct Ans-
5% of women birthing have either pre-existing or gestational. Of this:
87.5% gestational
7.5% type 1
5% type 2
when do we screen women with risk factors for diabetes? Correct Ans-
24-28 weeks
when do we screen women who have previously had GDM? Correct
Ans- as soon as possible after booking and the test repeated at 24-28
weeks if results are normal
how do we test for gestational diabetes? Correct Ans- Fasting blood test
called GTT
Fasting blood is taken (>5.6mmol/L)
75mg glucose drink given.
Women asked not to eat or drink anything and to move as little as
possible
Bloods retaken after 2 hours (>7.8mmol/L)
, what risks does GDM cause to the pregnant woman? Correct Ans-
hypoglycaemia (if using insulin)
Nausea and vomiting
Birth trauma
IOL and LSCS
Polyhydramnios
Stillbirth/miscarriage (5x more likely)
Potential for neonate to be admitted to NNU
Increased microvascular complications in pre-existing diabetics
Extended length of stay
What risks does GDM cause to the foetus? Correct Ans- Increased risk
of congenital malformations, particularly cardiovascular
increased risk of fetal distress in labour
stillbirth
growth over 90th centime
growth under 10th centime, depending on status of placenta
Birth trauma - fractured clavicle, humerus or erbs palsy
Polycythemia, due to relative hypoxia associated with diabetic red cells
and effect of fetal hyperinsulinaemia
Neonatal hypoglycaemia
Tendency to jaundice
Increased weight loss due to large size and increased fluid associated
with chronic hyperglycaemia
DETAILED ANSWERS|ALREADY GRADED A
Where is insulin produced? Correct Ans- beta cells of islets of
Langerhans in pancreas
What is type 1 diabetes? Correct Ans- autoimmune condition which
attacks beta cels in the pancreas resulting in the inability to produce
insulin
What is type 2 diabetes? Correct Ans- cells are resistant to insulin
What is gestational diabetes? Correct Ans- hormones produced in
pregnancy cause glucose to rise and result in insulin resistance over time
What are the risk factors for diabetes? (12 things) Correct Ans- First
degree relative
Ethnicity (South Asian, Black African, Black Caribbean)
High BMI (>30)
Age
Previous GDM
Previous macrosomic baby (>4.5kg)
Previous fetal/neonatal loss
Previous fatal anomaly
Hypertension
Multiple Pregnancy
,IVF pregnancy
PCOS
what are the symptoms of diabetes? Correct Ans- Fatigue/lethargy
Thrush infections/gential itching
Polydipsia (excessive thirst)
Delayed Healing
Polyuria (increased volume of urine)
Headaches/blurred vision/dizzy spells
Glycosuria (sugar in urine)
Shakiness
Unexplained weight loss
Clamminess/sweaty
Autoimmune condition
Muscle Weakness
Convulsions/fainting
Irritability
Ketotic breath
Loss of sensation in extremities
Pre-conceptual midwifery care for women with diabetes Correct Ans-
Avoid unplanned pregnancy
MOT prior to stopping contraception (including retinal and renal
function)
,Monthly HbA1c (should be below 48mmol)
Increased folic acid (5mg)
increased appointments during pregnancy
incidence rate of each kind of diabetes during pregnancy Correct Ans-
5% of women birthing have either pre-existing or gestational. Of this:
87.5% gestational
7.5% type 1
5% type 2
when do we screen women with risk factors for diabetes? Correct Ans-
24-28 weeks
when do we screen women who have previously had GDM? Correct
Ans- as soon as possible after booking and the test repeated at 24-28
weeks if results are normal
how do we test for gestational diabetes? Correct Ans- Fasting blood test
called GTT
Fasting blood is taken (>5.6mmol/L)
75mg glucose drink given.
Women asked not to eat or drink anything and to move as little as
possible
Bloods retaken after 2 hours (>7.8mmol/L)
, what risks does GDM cause to the pregnant woman? Correct Ans-
hypoglycaemia (if using insulin)
Nausea and vomiting
Birth trauma
IOL and LSCS
Polyhydramnios
Stillbirth/miscarriage (5x more likely)
Potential for neonate to be admitted to NNU
Increased microvascular complications in pre-existing diabetics
Extended length of stay
What risks does GDM cause to the foetus? Correct Ans- Increased risk
of congenital malformations, particularly cardiovascular
increased risk of fetal distress in labour
stillbirth
growth over 90th centime
growth under 10th centime, depending on status of placenta
Birth trauma - fractured clavicle, humerus or erbs palsy
Polycythemia, due to relative hypoxia associated with diabetic red cells
and effect of fetal hyperinsulinaemia
Neonatal hypoglycaemia
Tendency to jaundice
Increased weight loss due to large size and increased fluid associated
with chronic hyperglycaemia
