Medical Complication In Pregnancy - PowerPoint PPT Presentation

Loading...

PPT – Medical Complication In Pregnancy PowerPoint presentation | free to download - id: 456e5f-ZGFiZ



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Medical Complication In Pregnancy

Description:

Medical Complication In Pregnancy Diabetes At the beginning of the 20th century , diabetic women suffered from infetility, and the rare women achieving pregnancy ... – PowerPoint PPT presentation

Number of Views:182
Avg rating:3.0/5.0
Slides: 26
Provided by: basicShs
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Medical Complication In Pregnancy


1
Medical Complication In Pregnancy
  • Diabetes

2
  • At the beginning of the 20th century , diabetic
    women suffered from infetility, and the rare
    women achieving pregnancy faced a poor prognosis.
    Maternal death was a real threat,and perinatal
    survival a more 40 percent.

3
  • The availability of insulin since 1922, restored
    fertility and virtually abolished maternal
    mortality.
  • At the same time, perinatal survival did not
    change appreciatably. Since 1949 White
    Classification was developed, permitted
    individualized timing and mode of delivery, then
    perinatal mortality was reduced (nearly
    equivalent to that observed in normal
    pregnancies.)

4
I. Classification
  • Type I Diabetes Mellitus
  • ----insulin-dependent
  • ----immune-mediated and developed in
    genetically susceptible persons
  • ----concordance rate for diabetes in
    monozygous twins is less than 50

5
  • Type II diabetes
  • ----noninsulin-dependent
  • ----no HLA association
  • ----familial occurrence
  • ----concordance rate for diabetes in
    monozygous twins is 100

6
  • Gestational Diabetes Mellitus
  • Diabetes is the most common medical
    complication of pregnancy. Patient can be
    seperated into those diagnosed during pregnancy
  • It is estimated that 90 percent of all
    pregnacies complicated by diabetes are due to
    gestational diabetes
  • Approximately 15 percent of women with
    gestational diabetes will exibit fasting
    hyperglycemia

7
  • Classification during pregnancy
  • Table 1 gives a classification recommended by
    the American College of Obstetricians and
    Gynecologists in 1986.

8
class onset Fasting plasma glucose 2-hour postprandial glucose therapy
A1 Gestational lt105mg/dl lt120mg/dl Diet
A2 Gestational gt105mg/dl gt120mg/dl Insulin
Class Age of onset(yr) Duration(yr) Vascular disease Therapy
B gt20 lt10 None Insulin
C 10-19 10-19 None Insulin
D lt10 gt20 Benign retinopathy Insulin
F Any Any nephropathy Insulin
R Any Any Proliferative retinopathy Insulin
H Any Any Heart Insulin
T Any Any Transplantation of kianey Insulin
9
II. Diagnosis
  • (I)Diagnosis of Overt Diabetes during Pregnancy
  • i.presence of classical signs and symptoms
    (such as polydipsia, polyuria, unexplained weight
    loss)
  • ii.a random plasma glucose level greater than
    200mg/dl or fasting glucosegt 126mg/dl
  • iii.presence of ketoacidosis

10
  • (II)Diagnosis of gestational diabetes
  • i.High risk factors a familial history of
    diabetes, given birth to large infants,
    unexplained fetal losses, obesity
  • ii.Screaning
  • 50g oral glucose challenge test A value of
    140mg/dl(7.8mmol/l)or higher will identify 80 of
    all women with gestational diabetes

11
  • iii.Diagnosis criteria
  • If the results of 50g oral glucose challenge
    test exceed 7.8mmol/l, a diagnostic 100g oral
    glucose tolerance test is performed.

12
Table 2 American college of Obstetricians and
Gynecologists 1994 Criteria for Diagnosis of
GestationalDiabetes Using 100g of Glucose Taken
Orally
Timing of Measurement Plasma Glucose
National diabetes Data Group(1979) Carpenter and Coustan(1982)
Fasting 105mg/dl(5.6mmol/l) 95
1hour 190mg/dl(10.5mmol/l) 180
2hour 165mg/dl(9.2mmol/l) 155
3hour 145mg/dl(8.0mmol/l) 140
13
III.Maternal and Fetal Effects
  • I)Maternal Effects
  • i.increasing abortion rate
  • ii.increasing incidence of Pregnancy-Induced
    Hypertension(PIH)
  • iii.tend to be infection
  • iv.polyhydramnios
  • v.Macrosomia
  • vi.Be susceptible to ketoacidosis

14
  • (II)perinatal Effects
  • i.Macrosomia incidence is as high as 25-40
  • ii.Intrauterine Growth Retardation
    (restriction)
  • iii.Preterm Labor
  • iv.Fetal Anomalies
  • v.Stillbirth,Fetal death
  • vi.Congenital Malformations

15
  • (III)Infant Effects
  • i.Neonatal Respiratory Distress Syndrome
  • ii.Neonatal Hypoglycemia
  • iii.Hypocalcemia
  • iv.Hyperbilirubinamia

16
IV.Management
  • (I)Diet
  • Nutritional counseling is a cornerstone in
    management
  • The goals of such therapy are
  • i.To provide the necessary nutrients for the
    mother and fetus
  • ii.To control glucose level
  • iii.To prevent starvation ketosis

17
Table 3 Recommend Daily Caloric Intake and
Pregnancy Weight Grain in Women with Gestational
Diabetes with and without Concomitant Insulin
Therapy
Current Weight in Relation to Ideal Body Weight Daily Caloric Intake(kcal/kg) Recommend Pregnancy Weight Grain
lt80-90 36-40 28-40
80-120 30 25-35
120-150 24 15-25
gt150 12-18 15-25
18
  • (II)Insulin therapy
  • i.Indication---Insulin therapy is usually
    recommend when standard dietary management does
    not consistantly maintain the fasting plasma
    glucose at less than 105mg/dl or the 2-hour
    postprandial plasma glucose at less than 120mg/dl
  • ii.At the beginning, a total dose of 20-30
    units given once daily, before breakfast. The
    total dose is usually divided into two thirds
    intermediate-acting insulin and a third
    short-acting insulin

19
  • (III)Preconception
  • i.Control preconception glucose to optimal
    level(by using insulin)
  • ii.Hemoglobin AIc measurement

20
IV.Prenatal Care
  • (I)First trimester
  • i.Careful monitoring of glucose control is
    essential to management
  • ii.DietTotal caloric intake of 30-35kcal/kg
    of ideal body weight

21
  • (II)Second trimester
  • i.Maternal serum AFP
  • ii.Ultrasonoscan(at 18-20w) to detect
    neural-tube defects and other anomalies
  • (III)Third trimester
  • i.Weekly visits to monitor glucose control and
    to evaluate for preeclampsia
  • ii.Serial ultrasonography to evaluate fetal
    growth and amnionic fluid volume
  • iii.Other fetal surveillance tests
  • iv.Accept hospitalization from 34w until
    delivery

22
V.Delivery
  • (I)Timing of delivery
  • i.Women with gestational diabetes who do not
    require insulin
  • ii.Women with gestational diabetes who require
    insulin
  • iii.Overt diabetes women
  • iv.Others
  • v.If severe hypertantion,preeclampsia or other
    complications develop,delivery is carried out
    even though the ratio is less than 2.0 L/S

23
  • (II)Mode of delivery
  • i.In gneral, women with GDM(who does not
    requre insulin), the way of delivery is
    spontaneous labor
  • ii.Women with sonographic diagnosis of fetal
    macrosomia, elective induction of labor or
    cesarean section to prevent shouder dystocia
  • iii.In the overtly diabetic women(besides
    class A), cesarean delivery has commonly been
    used to avoid traumatic birth of a large infant,
    or to avoid maternal or fetal complication due to
    more advanced diabetes.Especially for those with
    vascular diseases

24
  • (III)Control the blood glucose
  • Maintain a near normal glycemia level
  • Reduce the dose of insulin on the day of
    delivery, and ½ postpartum
  • (IV)Prevention of infection

25
  • (V)Neonatal care
  • i.detecting of blood glucose, plasma calcium,
    plasma bilirubin
  • ii.Be care for a preterm neonatal
  • iii.To find respiratory distress and treatment
  • iv.Prevention of postpartun hemorrhge
About PowerShow.com