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RIS K FACTORS:

- Age >25 y.o.


- Overweigh t
- Gen etic histor y of DM
- Pre-existing DM
- Diet: food wi th high glycemic ind ex, poo r
qua lity car bohydrates, low-fiber
- Sed entary lifestyle
- Race (His panic, Americ an-Indian, Asian)

PA TH OPHYSIOLOGY
IUFD, UTERINE LACERATION, GDM,
ITP, NEPHROLITHIASIS, CYSTITIS

Human Placental Lactog en (hPL)


decrea ses ma ter nal sen sitivity to
insulin

lipo lysis activi ty

Estr ogen, Pro gestero ne, &


Cortiso l

hep atic insulin


resistan ce

amoun t of free Fa tty


Acids (FA)

Lack of insulin in ma tern al


circulation prevents glucose
from en ter ing cel ls

Imp aired glucose tol erance

feta l fat de positio n

Fetu s becomes L arge


for G estationa l A ge

Glu cose accu mu late s in


the bloodstream
Excess glucose
stor ed as fat

Feta l
hyperg lycemia

Maternal
Hyp erglyce mi a

Lon g term ma cro angiop ath y


complicatio ns

Lon g term microa ngiopa thy


complicatio ns

PVD, Arteriosclerosis,
CAD, CVD, MI, Stroke

Retinopathy, Nephro pathy,


Neurop ath y

intracellula r calcium

Macrosomia

(During del iver y) Higher


risk for: should er d ystocia,
clavicle fractu res, etc.

Inability of the pa ncr eas to


bala nce in suli n supp ly with
deman d that e xtend s up to the
2nd or 3rd trimester

Afte r sepa rati on from placenta


(deli very), supply of exce ssive
maternal glucose stops but fetal
insulin levels remain elevated

Ges tational Diabetes Mellitus

Severe immediate
hypogl ycemia upon birth

Urine pH foste rs
bacterial growth

Imp airs ne utro phil fu nction

Inc. bloo d viscosity

Pro ne to infection
Urinary Tract Infect ion: Cystitis
Glycosuria
Infla mmation pro cess
triggere d

(+) Bacteria on
urinaly sis

Polyuri a via
osmotic diure sis

capillar y permeab ility

Imp aired vascula r system

Fluid sh ifting from


the intr ace llular to
the intr ava scular

Cellula r de hyd ration


& star vation

Polydip sia
(+) Erythrocy tes
on urinaly sis

Dry ski n & mucous


membrane s

Localization of chemicals
such as prostagland ins

Polyph agia

Direct actio n o n n erve e ndings


Localization of ne utr ophils
& macropha ges for
pha gocytosis

(+) Dolor:
Dysuria, hypoga stric p ain

(+) Tumor compre ssing


nerve end ings

Hemoconcentrati on

Insu fficient transport of


oxygen, WBC, & nutrien ts
RIS K FACTORS:
- High so dium d iet
- Dehydration
- Poo r fluid intake
- High ca lciu m diet
- Metabolic diso rders
- Metabolic acidosis
(effe ct of DM)

Nephrolithias is
(Calcium oxalate stone s)

(+) Fever, chills

(+) Functio lae sa


temporary disturb ance i n
function

High WBC count


(+) Pus on urina lysis

(+) Urinary urgen cy

Weight of uterus pressin g


down on th e u reters

Calculi dislodgemen t into the


ureters or into the urethra

(+) Urinary fre quency


Obstructiv e uropathy

(+) Vira l Upper Res pira tory


Tra ct Infection

Acti vation of i mmune re spo nse s

Infla mmation pro cess


triggere d

Hyp er-acti vity of i mmune system

capillar y permeab ility


plasma tra nsfer from
the IV to the tissues

mucus pro duction

(+) Productive
cough / colds

Agg ravatio n o f ITP

Localization of chemicals
such as prostagland ins
(+) Dolor: sore
throat, dysphagia

Localization of ne utr ophils


& macropha ges for
pha gocytosis

(+) Tumor: clogge d no se

(+) Rubor: redd ened nose

(+) Fever, chills

Platelet count
(20 mg/dL)

Idiopat hic Throm bocyt openic


Purpura (ITP) diagnosed in 200 6

Antibod ies recog nize pl atel ets as


foreign bo dies an d a ttaches to it
Pha gocytic action resulting to
platele t destru ction

Platelet count
(20 mg/dL)

Failure to comple te clotting casca de i n re spo nse to


interna l & exte rnal tra uma to blood vesse ls

(+) Active bleeding

Ecc hym os is

Epistaxis
Pet echiae

Eas y bruising
Hemato ma formation

Sub con junctival hemorr hage


Gum bleed ing

Gra y-Turner s sign

IV volu me

Cullen s sign
Dec. Bloo d volu me circulating
by the placen tal barr ier

Bloo d p ressur e

Bar oreceptors trigge red

Feta l b lood oxyge nation

perfusion to the kidneys

Placen tal insufficiency

Acti vation of Ren inAng iote nsin system

Feta l re spo nse o f limitin g


oxygen demand in response to
limited oxygen suppl y

(+) Late decelera tion as


observed duri ng FHT
monitoring

Renin secretio n

Feta l h eart ra te
Conversion of
Ang iote nsinogen to
Ang iote nsin I by Renin

Cerebr al h ypo xia

Fetal body m ove ment


Intrauterine Fetal Dem ise
(IUFD)

(-) Fetal heart tone

Conversion of An giotensin I to
Ang iote nsin II by Angiotensinconverting enzyme (ACE)

(-) Fetal m ov ement


Aldo steron e r elease

If not e xpe lled fro m the ute rus


immediately: Maceration

(<8 hrs) Maceration: Par boiled


redd ened skin

(>8 hrs) Maceration: Skin


slippag e & pee ling

(2-7 days) Maceration:


Exte nsive skin pe eling, red
effu sion s in skin (chest/
abd ominal area)

RIS K FACTORS:
- Macros om ic fetus
- Oxy toc in augme nta tion
-VBAC
- Close inte rva l between
pre gnancies (2 yrs.)
- Dysfunctio nal labor

Na+ & water r eten tio n

Compensatory in cre ase in BP

Pre viou s uterine


trauma fro m CS

VBA C performed
2 yrs afte r CS

Scar tissue fo rma tion

Dehiscence o f
sca rred area

Ineffective contractio n o f th e
myo me triu m after de live ry

Macrosomic fe tus +
oxytocin augmen tation

(>7 days) Mummification


Inco mp lete closure
of b lood ve ssels

Continuous bleeding
into the endometrium

Uterine la ceration

Inc. Heart r ate


(Compensatory
mechanism)