ABNORMAL OGTT 34 YR OLD 24 Flashcards
HX
-have you had hx DM or Family Hx
-any previous sx or illness
-is this first baby?
-how far along .28weeks
-USS at 18 week? normal
examination findings?
blood pressure, proteinuria
fundal height
presentation : cephalic, head still mobile pelvic brim
fetal HR
explanation
the diagnosis is GDM,
consultation with diabteic physician, OBGYN mandatory :VIMP
should follow special diet to keep glusose<7, ir not controlled insulin therapy probably necessary
test blood surgar 3-4 times a day, 2hrs Vafter meal : VIMP
RISKS
-macrosomia uss 32wks
-IUFD -weekly CTG, CTG 2 week if on insulin
-Hyalin Membrane disease : delay pregnancy untill 37 weeks, steroid can be used but make GDM worse
RISK TO MOTHER
-pre-eclempsia
DELIVERY
-at term latest, unless obstertric complication earlier,
-monitor fetus CTG during labour
-keep glucose stable with insulin
-deliver CS: >90 percentile size, breech, fetal distress
PROGNOSIS
-Diabetes will almost certainly resolve after delivery
-GDM likely in subsequent pregnancies
-30 percent chance DM later: 5yrlt glucose tolerance
-control weight gain
task
This patient is a 34-year-old obese primigravida whom you are managing in a country general
practice. She has had a screening glucose tolerance test performed at 28 weeks of gestation.
This revealed a fasting blood glucose of 7.5 mmol/L and a two hour level of 9.5 mmol/L (Normal
levels — fasting < 5.5 mmol/L; two hour < 8.0 mmol/L).
Progress of her pregnancy has until now been normal. No other investigations have been done
apart from routine screening tests at the first antenatal visit which were all normal.
YOUR TASKS ARE TO:
* Take any further relevant history you require. This should be limited to 1-2 minutes only.
* Ask the examiner for the findings you would expect on general and obstetric examination.
* Advise the patient of the diagnosis you have made.
* Advise the patient of the management you would give in the remainder of the pregnancy.
