PATHOLGIC OBSTETRICS PART 2 GESTATIONAL DIABETES

S/Sx of Type 2 DM ---> Pregnancy

3 DELAYS MODEL ▪︎Abnormal caloric metabolism FIRST diagnosed

during pregnancy
1. Delay in Seeking AppropriateMedical Help
☆Sustained HYPERGLYCEMIA
2. Delay in Reaching Obstetric Facility
3. Delay in Receiving Adequate Care in the
Facility Dx Test/s:
OGTT - oral glucose Tolerance Test

● AMNIOTIC FLUID ANALYSIS confirmatory test for GDM

ABNORMAL VOLUME: - 24-28 weeks

》500 - 2000 ml 75 grams

▪︎Oligohydramnios (Glucose) -2° - Blood Glucose Level

<500 ml ☆ 95- 140 mgldl

(PROM, kidney problem - fetus) >140mg/dl = GDM

▪︎Polyhydramnios
> 2000 ml CLASSIFICATION:
(GI/Swallowing problem - fetus) ▪︎a. A1
OGTT: Abnormal – no S/Sx

ABNORMAL: FBS: 80-120 - Normal

PORT-WINE stained Control: Diet Management

▪︎A Dark Brown Blood - ABRUPTIO Placenta ▪︎b. A2

(Breech - expected) OGTT: Abnormal
▪︎MECONIUM stained FBS: Abnormal
Cephalic - Abnormal- Fetal Distress Control: Insulin
Light Brown - fetal distress -Resolve
Oral Hypoglycenuic Agents (OHA)
Greenish - Active Fetal Distress
(Teratogenic)
▪︎FOUL-SMELLING
☆ Cause: INSULIN Antagonist effect of
(Malodorous) Placental Hormone
-indicates puerperal Infection
▪︎(+) for AFP (alpha-fetoprotein)
Neural Tube Defect
☆ Spina Bifida
S/Sx:
a. Glycosuria on 2 SUCESSIVE vists
b. Recurrent monilial vaginitis (fungal
infection)
c. MACROSOMIA of the on UTZ
(abnormally large fetus)
d. Polyhydramnios

Infant of Diabetic Mother

ACTION:
Newborn Complications:
▪︎a. Proper Nutrition
a. ☆ Fetal Hypoglycemia
( Balanced Diet)
b. MACROSOMIA
▪︎b. Self-monitoring of Glucose
c. SHOULDER DYSTOCIA
(CBG)
d. SHOULDER INJURY (Brachial Plexus)
▪︎c. Insulin Administration
• Pregnancy - Late Trimester - insulin
requirement ABORTION (Miscarriage)

Watch out for: ▪︎termination of pregnancy before the AGE

of VIABILITY
▪︎d. WOF Ketonuria
○ Age of viability - 20 weeks
(+) Ketones urine = EMERGENCY
○ Fetal weight - < 500 grams

MATERNAL:
CAUSES: (1st Tri.) 3 mos.
** DKA - Diabetic Ketoacidosis
MOST COMMON:
Risk for:
☆ CHROMOSOMAL Abnormalities
a. Spontaneous Abortion
○ Teratogenic substance
b. PIH
○ Chronic Disease
c. Preterm Labor
▪︎Hormonal imbalance
d. Birth complications -Dystocia
》Acetone Breath- Fruity
CAUSES (14 -20 WEEKS) 4-5th months
》 Kaussmal's Respiration
▪︎Infection
》 Coma
▪︎Incompetent cervix – Habitual
▪︎Uterine Defects/Tumors
▪︎Trauma

According to Nature of Expulsion

▪︎Spontaneous (expulsion- Natural)
▪︎Induced (human manipulation)
Type Description Cervix Bleeding Action
Threatened

Imminent/
Inevitable

Incomplete

Complete

Missed

Septic

Habitual