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- 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)


Human Placental Lactog en (hPL)

decrea ses ma ter nal sen sitivity to

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

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


(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
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
- 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

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

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

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

(-) 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)

- Macros om ic fetus
- Oxy toc in augme nta tion
- 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