1 ln qestotiono/ diobetes Lhe body ls unable Lo make or use all Lhe lnsulln lL needs Lo supporL Lhe

pregnancy regnancy changes how lnsulln works ln Lhe body whlch may lead Lo dlabeLes LxperLs arenL
sure why gesLaLlonal dlabeLes happens Some research suggesLs Lhe placenLa (whlch works Lo nourlsh Lhe
growlng baby) may block how lnsulln works ln Lhe moLhers body CesLaLlonal dlabeLes ls LreaLed wlLh a
healLhy dleL exerclse good prenaLal care and someLlmes lnsulln CfLen gesLaLlonal dlabeLes goes away
afLer Lhe baby ls born
1here are 2 Lypes of gesLaLlonal dlabeLes
1ype A1 Cnly dleL modlflcaLlon ls enough Lo conLlnue regular glucose levels
1ype A2 lnsulln or addlLlonal medlclnes wlLh dleL are necessary Lo preserve normal range of blood
glucose

2 Metabo||sm
All meLabollc funcLlons are lncreased durlng pregnancy Lo provlde for Lhe demands of feLus placenLa and
uLerus as well as for Lhe gravldas lncreased basal meLabollc raLe and oxygen consumpLlon roLeln
meLabollsm ls enhanced Lo supply subsLraLe for maLernal and feLal growLh laL meLabollsm lncreases as
evldenced by elevaLlon ln all llpld fracLlons ln Lhe blood CarbohydraLe meLabollsm however
demonsLraLes Lhe mosL dramaLlc changes MeLabollcally speaklng pregnanL women llve ln a sLaLe of
acceleraLed sLarvaLlon llrsL nuLrlLlonal demands of Lhe growlng feLus are meL by Lhe lnLake of glucose
and second secreLlon of lnsulln ln response Lo glucose ls augmenLed As early as 13 weeks of gesLaLlon
maLernal blood glucose levels afLer an overnlghL fasL are conslderably lower Lhan ln Lhe nongravld sLaLe




og|naem|a CpLlmal blood glucose levels ln pregnanL women range beLween 44 Lo 33 mmol/1 (80 Lo
100mg/dl) ln healLhy nonpregnanL lndlvlduals slgns of hypoglycaemla usually begln when Lhe blood glucose level
decllnes Lo approxlmaLely 22 mmol/1 (40mg/dl) ln pregnanL women however hypoglycaemla ls deflned as a
concenLraLlon below 33 mmol/1 (60mg/dl) Pypoglycaemla lnlLlaLes Lhe release of glucagon corLlsol and
lmporLanLly caLecholamlnes ln Lhe anaesLheLlsed sLaLe however Lhese compensaLory mechanlsms parLlcularly
Lhe release of eplnephrlne (adrenallne) are blocked AuLonomlc derangemenLs ln Lhe form of hypoLenslon and
Lachycardla Lend Lo ensue durlng hlgh reglonal blockade or deep general anaesLhesla whlch may mask Lhe
sympLoms and slgns of hypoglycaemla

3 Plnul kC ALAM SACC1!







4
bort|on 1es Charanter|st|ns Management

1bteoteoeJ Abottloo
occurrlng before Lhe 20Lh week
of gesLaLlon
characLerlzed by cramplng and
vaglnal bleedlng wlLh no cervlcal
dllaLlon
lL may subslde or an lncompleLe
aborLlon may follow
1 8edresL
2 no colLus up Lo 2 weeks afLer
bleedlng sLopped
loeot ot oevltoble Abottloo membranes rupLure and Lhe
cervlx dllaLes
characLerlzed by lower
abdomlnal cramplng and
bleedlng
1 PosplLallzaLlon
2 u and C
3 CxyLocln afLer u and C
4 SympaLheLlc
3 undersLandlng and emoLlonal
supporL
ocolete Abottloo ls characLerlzed by expulslon of
only parL of Lhe producLs of
concepLlon (usually Lhe feLus)
severe uLerlne cramplng
bleedlng occur wlLh cervlcal
dllaLlon
1 u and C
2 CxyLocln afLer u and C
3 SympaLheLlc
4 undersLandlng and emoLlonal
supporL

colete Abottloo
characLerlzed by compleLe
expulslon of all producLs of
concepLlon
llghL bleedlng
mlld uLerlne cramplng
passage of Llssue
closed cervlx
1 1here ls no LreaLmenL oLher
Lhan resL ls usually needed
2 All of Lhe Llssues LhaL came ouL
should be saved for examlnaLlon
by a docLor Lo make sure LhaL
Lhe aborLlon ls compleLe
3 1he laboraLory examlnaLlon of
Lhe saved Llssue may deLermlne
Lhe cause of aborLlon
,lsseJ Abottloo lnLrauLerlne pregnancy ls
presenL buL ls no longer
developlng normally
Lhe cervlx ls closed and Lhe
cllenL may reporL dark brown
vaglnal dlscharge
pregnancy LesL flndlngs are
negaLlve
1 usually LreaLed by lnducLlon of
labor by dllaLlon (or dllaLaLlon)
and cureLLage (u C)
8ecurrenL orobltool Abottloo characLerlzed by sponLaneous
aborLlon of Lhree or more
consecuLlve pregnancles
1 1race Lhe cause of recurrenL
aborLlon
etlc Abottloo aborLlon compllcaLed by
lnfecLlon
foul smelllng vaglnal dlscharge
uLerlne cramplng
fever
1 AnLlbloLlcs as prescrlbed by your
CbsLeLrlclan

3
Difference Between PIacenta Previa and Abruption PIacenta
Category PIacenta Previa Abruptio PIacenta
Problem Low implantation of the placenta Premature separation of the placenta
ncidence t occurs in approximately 5 in every 1000
pregnancies
t occurs in about 10% of pregnancies and is the most
common cause of perinatal death.
Bleeding Always present May or may not be present
Color of blood in
bleeding episodes
Bright red Dark red
Pain during bleeding Painless Sharp, stabbing pain
Management Bed rest (side lying position)
NO vaginal or pelvic examinations
Assessment of FHR and bleeding
Lateral position
No vaginal or pelvic examinations
Termination of pregnancy
Fluid replacement
Oxygen by mask
Monitor FHR
Keep the woman in a lateral position
DO NOT perform any vaginal or pelvic
examinations or give enema
Pregnancy must be terminated because the fetus
cannot obtain adequate oxygen and nutrients. f
birth does not seem imminent, cesarean birth is
method of choice for delivery.

arameLers lacenLa revla AbrupLlon placenLa
a placenLal locaLlon
b Lype of bleedlng
c presence of paln
d changes ln Lhe uLerlne
cavlLy
e how ls lL dlagnosed