Chapter 14 Study Guide .docx - Chapter 14 Pregnancy at Risk...

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Chapter 14: Pregnancy at Risk: Presentational Problems Care of the Woman with Diabetes Mellitus - DM is an endocrine disorder which results from inadequate production or use of insulin. Carbohydrate Metabolism in Normal Pregnancy In early pregnancy the rise in serum levels of estrogen, progesterone, and other hormones stimulates increased insulin production by the maternal pancreas and increased tissue response to insulin. In the second half of pregnancy placental secretion of human placental lactogen (hPL) and prolactin, as well as elevated cortisol and glycogen levels, cause increased resistance to insulin and decreased glucose tolerance. Pathophysiology of Diabetes Mellitus In DM, the pancreas fails to produce insulin or does not produce enough insulin to allow necessary carbohydrate metabolism. Without adequate insulin, glucose does not enter the cells and they become energy depleted. Four cardinal signs and symptoms of DM o Polyuria (frequent urination) o Polydipsia (Excessive thirst) o Polyphagia (excessive hunger) o Weight Loss (seen with marked hyperglycemia) Classification Type 1 Diabetes: Develops because of B – cell destruction and results in an absolute insulin deficiency. Type 2 Diabetes: Most common, results from a combination of an insulin secretory defect and increased insulin resistance. Other Specific Types Gestational DM: Is defined as any degree of glucose intolerance that has its onset or is first diagnosed during pregnancy. It is not a pre-existing condition. Influences of Pregnancy on Diabetes During the first trimester, the need for insulin frequently decreases. N/V may cause dietary fluctuations and increase the risk of hypoglycemia. Insulin requirements begin to rise late in the 1 st trimester. Insulin requirements may double or quadruple by the end of pregnancy as a result of placental maturation. Increased energy needs during labor may require increased insulin to balance intravenous glucose. After delivery of the placenta, insulin requirements usually decrease abruptly. The risk of ketoacidosis may occur at lower serum glucose levels in a pregnant woman with DM than in a nonpregnant woman with diabetes, increases. The vascular disease that accompanies DM may progress during pregnancy. Hypertension may occur. Nephropathy may result from renal impairment. Influences of Diabetes on Pregnancy Outcome
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o Maternal risk Diabetic pregnancy still carries a higher risk of complications than normal pregnancy. The risk of developing diabetes later in life is increased in women with GDM. Hydramnios – an increase in volume of amniotic fluid, occurs in 10 – 20% of pregnant women who have diabetes. Is a result of excessive fetal urination because of fetal hyperglycemia.
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