Evolve Maternity Case Studies

GTPAL
G: The number of times pregnant, including current pregnancy
T: Any birth after the end of the 37th week
P: Any births between 20 and 37 weeks
A: any fetal loss, whether spontaneous or elective up to 20 weeks
L: All children who are living at the time

Multiple fetsuses such as twins are treated as one pregnancy and one birth from T/P

Gestational Diabetes Risk Factors
-Birth of an infant weighing >9lbs (4,100 grams)
-Maternal age older than 25
-Obesity
-History of unexplained stillborn
-Family hx of type 1 diabetes in a first degree relative
-Strong family hx of type 2 diabetes
-hx of gestational diabetes in previous pregnancy
-Ethic groups: Hispanic, Native-American, Asian, and African-Americans are also at higher risk

Protein in Urine
Trace protein in the urine is normal during pregnancy

1 hour and 3 hour glucose tolerance test
1 hour – 50 g.
(-) <140 mg/dL (+) >140 mg/dL, proceed to 3 hour

3 hour – 100 g
(+) Meet or exceed:
Fasting: 105 mg/dl
1 hour – 190 mg/dl
2 hour – 165 mg/dl
3 hour – 145 mg/dl

Avoid caffeine and smoking, which can alter the glucose readings

Gestational Diabetes Testing and Physiology
Not tested until 28 weeks
Hormonal changes in the 2nd and 3rd trimesters result in increased maternal insulin resistance.

Increased levels of hormones increase insulin resistance because they act as insulin antagonists. This serves as a glucose-sparing mechanism to ensure an adequate glucose supply to the fetus. While most pregnant women’s bodies are able to handle this insulin resistance, women with gestational diabetes cannot and therefore demonstrate an impaired tolerance to glucose during pregnancy and develop hyperglycemia.

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