A 23-year-old patient in the clinic has just had her pregnancy confirmed by the physician. She...

A 23-year-old patient in the clinic has just had her pregnancy confirmed by the physician. She has a history of Type I diabetes.

As a result of her high-risk status, what are some additional assessment measures that need to be emphasized during her prenatal care?

What stressors might this patient and her family have to deal with as a result of her status as a pregnant diabetic woman?

Solutions

Expert Solution

ADDITIONAL ASSESSMENT MEASURES DURING THE PRE NATAL CARE

Ultrasound:
- Ultrasound evaluation of the fetal growth, estimating fetal weight and detecting hydramnios and malformations
- ultrasound evaluation of the neural tube defects at 15-21st week of pregnancy
- at 20- 22 weeks- Echo must be done to detect cardiac defects
- third trimester: USG surveillance to detect any still birth
Maternal serum Alpha Fetoprotein (MSAFP) : Done at the 16th week of gestation to detect the neural tube defects in the newborn
NST ( Non Stress Test):
- evaluates the fetal well being
- done weekly at 28-34 weeks and then bi weekly after 34 weeks
GTT ( Glucose Tolerance Test): a fasting plasma glucose levels of >125 mg/dl meets the threshold for diagnosis of diabetes
urine for ketone and glucose
glycosylated hemoglobin (HbA1C) : which measure the percentage of the hemoglobin with glucose attached

STRESSORS

pre eclampsia
infections ( chorioamnionitis and post partum endometritis)
post partum bleeding
excessive weight gain
miscarriages
cardiomyopathy/ retinopathy/ nephropathy
neonatal hypoglycemia
neonatal RDS
Intra uterine fetal death
congenital anomalies
risk for injury to the fetus related to uteroplacental insufficiency
risk for injury to the mother related to complications associated with diabetes
risk for infection related to impaired skin integrity related to skin streching due to hydramnios

Nightingale answered 1 year ago

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