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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?

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Expert Solution

ADDITIONAL ASSESSMENT MEASURES DURING THE PRE NATAL CARE

  1. 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
  2. Maternal serum Alpha Fetoprotein (MSAFP) : Done at the 16th week of gestation to detect the neural tube defects in the newborn
  3. NST ( Non Stress Test):
    • evaluates the fetal well being
    • done weekly at 28-34 weeks and then bi weekly after 34 weeks
  4. GTT ( Glucose Tolerance Test): a fasting plasma glucose levels of >125 mg/dl meets the threshold for diagnosis of diabetes
  5. urine for ketone and glucose
  6. 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 2 years ago
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