OBGYN EOR Flashcards
what is the discriminatory zone for visualization of the gestational sac?
bhcg of 1500
bHCG for GTBD
> 100,000
ddx for very low but persistent bHCG
placental site trophoblastic tumor
very malignant
vasa previa
fetal vessel lies over the cervix
Placenta accreta
superficial attachment of the placenta to uterine myometrium
placenta increta
invades myometrium
placenta percreta
invades through myometrium to uterine serosa
MCC og third trimester bleeding
placental abruption
Couvelaire Uterus
life threatening condition that occurs where there is enough blood from abruption that markedly infiltrates myometrium to reach the serosa, especially at the cornea, that gives the myometrium a bluish purple tone that can be seen on the surface of the uterus
MC maternal complication of placental abruption
Consumptive Coagulopathy (DIC) –> leads to thrombocytopenia & hypofibrinogenemia
INCREASED INR & PTT
ideal time for delivery w/ placental abruption
34-37 weeks
- normal fetal heart tracing characterized by normal baseline
- moderate variability
- NO variable or late decels
category I FHR tracing
- many variety of fetal heart tracings
- variable & late decelerations
- bradycardia/ tachycardia
- minimal variability/marked variability
- absent variability w/o decel
category II FHR tracing
- absent fetal heart variability
- recurrent late of variable decels or bradycardia
- sinusoidal pattern (c/w fetal anemia)
Category III
common tocolytic therapy
Indomethacin
Nifedipine
Mag sulfate
Terbutaline
Mag Sulfate Toxicity
Toxic levels > 10 mg/dL
Causes respiratory depression, hypoxia, cardiac arrest, decreased DTRs
therapeutic levles = 4-8 mg/dL
indomethacin
tocolytic commonly used before 32 weeks gestation for 48-72 hours
FOUR primary causes of preterm labor
- Premature activation of maternal HPA axis
- Exaggerated inflammatory response OR Infection
- Abruption (decidual hemorrhage)
- Pathological uterine distention
effects of increase ACTH during pregnancy
increased ACTH → increased cortisol → increased prostaglandins → cervical ripening/rupture of membranes
prolonged rupture of membranes
> 18 hours (RF for chorioamnionitis)
preterm rupture of membranes (pPROM) tx (before 36 weeks)
typically requires delivery by 34 weeks (avoid infection)
manage with steroids, abx (ampicillin, erythromycin), tocolysis,
erythroblastosis fetalis/fetal hydrops
Hyperdynamic state, heart failure, diffuse edema, ascites, pericardial effusion d/t serious anemia
MC RF for preeclampsia
nulliparity
Delivery threshold for women with preeclampsia
> 32 weeks
prophylaxis indicated in subsequent pregnancies in moms with pmh of preeclampsia
aspirin
calcium supplementation
GDM blood sugar levels
Fasting: 90
1 hr: 165-180
2 hr: 145-155
3 hr: 125-140
when do you screen post partum for DM in mom w/ hx of GDM?
6 weeks
when to induce in GDM
40 weeks if well controlled
38 weeks if poorly controlled/macrosomia
** typically want to induce by 37 weeks to prevent preE **
Chorioamniotis
maternal fever, uterine tenderness & leukocytosis & fetal tachycardia
Tx = IV abx & delivery
anti-epiletics CI in pregnancy
Valproate & Depakote
switch to keppra or lamictal
Amount of Caffeine safe in pregnancy
< 150 mg/day
Sheehan Syndrome
absence of lactation 2/2 to lack of prolactin or failure to restart menstruation 2/2 to absence of gonadotropins
High fever, leukcytosis, uterine tenderness, post section (5-10 days)
consider endomyometritis
Polymicrobial infection of the uterine lining that often invades underlying mucle wall - MC after a C-section but may occur after vaginal deliveries as well
CI to a Fetal Version for Breech Postion
- nulliparity
- est fetal weight > 38000g
- incomplete breech position
- previous Csection
- ## placenta previa
when is an external version typically initiated for malposition?
37 weeks
MC form of delivery
spontaneous vertex vaginal delivery
Cardinal Movements of Labor
Engagement
Descent
Flexion
Internal rotation
Extension
External rotation (restitution/resolution)
expulsion
when does active phase of labor start?
cervical dilation > 4 cm
stage 1 of labor
Onset of labor to complete dilation & effacement of cervix
includes both latent and active phases
how often are you performing cervical exam during first stage of labor?
Q2-4 hours
stage 2 of labor
Time of full dilation → delivery of infant
cut off for prolonged second stage of labor
> 2 hrs in nulliparous
> 1 hour in multiparous
stage 3 of labor
after delivery of infant to delivery of placenta
1st degree tear
mucosa/skin
2nd degree tear
extends into perineal body but not involving anal sphincter
3rd degree
extends into or through anal sphincter
(must repair anal sphincter w/ several interrupted sutures)
+/- broad spectrum abx
4th degree
anal mucosa itself is entered
(repair anat sphinter
“Button wall” - laceration through rectal mucosa into vagina, but with sphincter still intact)
may require antibiotics, debridement and secondary closure
complications of 3rd and 4th degree lacerations
wound breakdown, infection, incontinence, and prolapse.
non-reassuring fetal status
repetative decels, bradycardia (< 100-110), loss of variability
Immediate tx for nonreassuring fetal status
- O2
- turn on left side to decrease IVC compression & increase uterine perfusion
- d/c oxytocin
where is a spinal epidural placed?
L3-4
Naegle’s rule
LMP – 3 months + 7 days
GTPAL
Gravida (# total pregnancies)
Parity (# deliveries)
TPAL term, preterm, abortion, live
when does fetal movement start?
18-20 weeks - primigravida
14-18 - multi
when can you detect cardiac activity?
6 weeks
most accurate way to determine delivery date?
crown-rump length
when is fetal yolk sac visible?
5 weeks
1st Trimester Testing
heme: CBC, Crit, blood type/ab screen
infx: RPR, rubella ab, hep B surface antigen, VZV ab, PPD
urine: UA + urine culture
genetic: nuchal translucency
nuchal translucency testing
performed at 10-13 weeks for trisomies 13, 18, 21,
Turner syndrome
what if there is wide nuchal fold on nuchal translucency test ?
perform CVS or amniocentesis
CVS - allows for
first trimester termination
risk of CVS = amnio
2nd trimester testing
15-18 weeks: maternal AFP
triple/quad screen
15-18 weeks: +/- amnio if AMA (if pmh or pervious screening indicates need)
18-20 weeks: anatomy scan (US)
what does high vs Low AFP mean?
increase = neural tube defects
decrease = down syndrome
what is included in triple screen
bHCG + estriol + MSAFP
what is included in quad screen?
bHCG + estriol + MSAFP + inhibin A
low uncongugated estrogen
low AFP
high inhibin A
trisomy 21
high AFP
neural tube defects
3rd trimester testing
24-28 weeks:
- OGTT
- vaginal G/C repeated (if high risk)
- HSV testing
36 weeks
- GBS screen
external doppler/NST/ BPP
when do you initate antiviral prophy for latent HSV
36 weeks
Normal NST
2 accelerations in 20 mins of 15 bpm from baseline for 15 seconds
persistent late decels on NST
a decline in fetal HR 15bpm lasting more than 15 seconds or slow return to baseline
what is a BPP
NST + amniotic fluid level, gross fetal movements, fetal tone, fetal breathing
2 pt each
highs core in BPP is an indicator for higher risk of ?
asphyxia
(suffocation)
MCC with multiple gestations
preterm labor/delivery
placenta previa
postpartum hemorrhage
pre-eclampsia
cord prolapse
malpresentation
congenital abnormalities
monozygotic twins are at increased risk of what condition?
twin-twin transfusion syndrome
mo-mo twins
single placenta
one chorion
one amnion
mono-di twins
single placenta
single chorion
two amniotic sacs
di-di twins
two placenta
two chorion
two amniotic sacs
total weight gain goal for multiple gestations
37-54 lbs
tx for preeclampsia w/ severe features
delivery (regardless of gestational age)
Antenatal corticosteroids required for patients diagnosed with preeclampsia if the gestational age is < 34 weeks. planf or delivery after 48 hours
What is the first sign of hypermagnesemia in patients being treated with magnesium sulfate to prevent seizure
loss of patellar reflex
prevention for preeclampsia
low dose aspirin beginning at weeks 12-28 (ideally before 16 weeks)
GDM Criteria
3-hour 100 g OGTT results
> 95 mg/dL fasting
180 mg/dL at 1 hour
155 mg/dL at 2 hours
140 mg/dL at 3 hours
single most common identifiable RF for PPROM?
genital tract infections
most sensitive finding for chorio?
maternal Fever > 102.2 F w/o clear source
chorio diagnostic criteria
one or more of the following:
- purulent-appearing fluid coming from the cervical os visualized during speculum examination
- maternal white blood cell count > 15,000/μL
- baseline fetal heart rate of at least 160 bpm for at least 10 minutes.
PLUS one or more of the following:
- positive Gram stain of amniotic fluid
- positive amniotic fluid culture
- low glucose level in amniotic fluid
- high white blood cell count in amniotic fluid
- histopathologic evidence of infection or inflammation of the placenta/fetal membranes/ umbilical cord vessels
tx of chorio
IOL + ampicillin & gentamicin
add metronidazole/clindamycin for anerobe coverage if c-section is warranted
MC organisims of chorioamnionits
GBS
E.Coli
what level mag toxicity do you loose patellar reflex
> /= 10 mg/dL
respiratory failure >/= 15 mg/dL
cardiac arrest >/= 25 mg/dL
tx for mag toxicity
calcium gluconate
target BP goals for preeclampsia patients
130 to 150 mm Hg systolic
80 to 100 mm Hg diastolic.
when are antihypertensives indicated in preeclampsia
> /= 160 sbp or >/= 110 dbp
preeclampsia criteria
New-onset hypertension (≥ 140/90 mm Hg)
PLUS proteinuria (≥ 300 mg/24 hr or urine OR protein:creatinine ratio ≥ 0.3)
significant end-organ dysfunction
Cervical cerclage reccomended at what length?
< 25 mm
(can place between 12-14 weeks)
reactive fetal HR
- 2 accelerations of 15 bpm above baseline
- for 15 seconds each
- in a 20-minute period
what is misoprostol?
initiates cervical dilation and uterine contractions
used in IOL & in combo w/ mifeprestone during abortion tx
polyhydramnios is a complication of which d/o?
GDM
polycythemia is a complication of what d/o?
GDM
common sequelae of episiotomy
dyspareunia
most important RF for post partum endometritis?
C-section
tx of endometritis
clindamycin + gentamicin
endometritis triad
fever + foul smelling lochia + abdominal pain
oxytocin role in breastfeeding?
milk ejection (let down reflex)
4 T’s PPH
truama
tone (MC)
tissue
thrombin
rare complication of endometritis?
septic pelvic thrombophlebitis
consider in pt w/ endometritis who does not improve w/n 3-5 days
palpable cord like mass (supportive finding)
requires abx + anticoagulation
when can you resume intercourse after a uncomplicated vaginal delivery?
2 weeks
endometritis tx for pt post c-section?
clindamycin + gentamicin
c-section prophylaxis for endometritis?
first gen cephalosporin
what contraception is CI first 6 weeks postpartum?
Combined OCPS
increased risk of VTE
which type of episiotomy reduces anal sphincter damage?
mediolateral
CI to breastfeeding?
active HIV
when does ovulation resume in postpartum women?
45 days in nonlactating women
189 days in lactating women.
most common type of invasive breast cancer?
infiltrating ductal carcinoma
spiculated soft tissue mass on US?
breast cancer
tx of estrogen receptor positive breast cancer
chemo + letrozole/tamoxifen
In a postmenopausal woman being assessed via transvaginal ultrasound, what is the endometrial thickness threshold that requires follow-up with endometrial sampling?
> 4 mm
MC type of vulvar cancer?
squamous cell carcinoma
what hormone is elevated in menopause?
FSH
Failure of menses to occur by age 15 despite normal development of secondary sex characteristics
primary amenorrhea
Failure of menses to occur by age 13 in the absence of secondary sex characteristics
primary amenorrhea
abruption tx
< 34 weeks: beta + mag
34-36 weeks: consider beta
> 36 weeks: delivery
both physical & mental symptoms that interfere with aspect of life occuring during luteal (2nd half) of menstrual cycle that resolve w/ onset of menses
PMS
physiological change preventing PPH?
uterine involution
What additional studies are recommended in patients with nonreassuring patterns on fetal heart tracings?
Fetal scalp stimulation or fetal scalp pH measurement
Prominent fibroglandular tissue with small cysts but no discernable mass
fibrocystic changes
All pt > 45 y/o w/ AUB require what testing?
endometrial tissue sampling
which hormone is responsible for uterine ripening to allow proper implantation of a fertilized ovum?
progesterone
postcoital bleeding is c/f which diagnosis?
cervical cancer
most common type of gonadal dysgenesis
Turner Syndrome (45, XX)
hypoechoic, round, well-circumscribed uterine mass
fibroid
what must be included in hormone treatment in any woman w/ a uterus?
progesterine (cannot have unopposed estrogen)
osteoporosis screening in women?
65 y/o
when do PMS symptoms present in a cycle?
end of the luteal phase (aka right before menses)
days 23-27
leuprolide
GNRH analog - suppresses FSH & LH
can be used to shrink fibroids (however can cause menopausal sx)
postpartum hypopituitarism
sheehan syndrome
rare complication of postpartum hemorrhage 2/2 to blood loss & hypovolemic shock that leads to pituitary gland ischemia
MC site of endometriosis
ovaries
MOA of TXA?
prevents the conversion of plasminogen –> plasmin (aka decreased fibrinolysis)
risk of long-term combined menopausal hormone therapy?
breast cancer
failure of menses to appear by AGE 15 w/ normal growth & secondary sex characteristics
requires amenorrhea workup
failure of menses by age 13 w/ absence of secondary sex characteristics
requires primary amenorrhea workup
abnormally prolonged (> 7 days) or heavy (> 80 mL) uterine bleeding that maintains a normal menstrual cycle
menorrhagia
abnormal uterine bleeding in between normal cycles that recur at irregular intervals
metorrhagia
abnormal uterine bleeding that is heavy or prolonged & occurs at irregular intervals (more frequently than normal menstruation)
menometorrhagia
labs in SEVERE abnormal uterine bleeding
CBC, CMP, PT, PTT, INR & TSH
mullerian agenesis is characterized by what clinical finding?
absence of uterus and cervix (and vaginal agenesis)
how many hours apart do BP readings need to be for dx of preE
4 hours (if >140 or >90)
w/n minutes if severe ranges (>160 or > 110)
what proteinuria is needed for PreE dx
> 300 mg / 24 hour urine
PCR > 0.3
dipstick > 2+
at what point can preE be dx in pregnancy?
20 weeks
preE w/ severe fx requires delivery by which date?
32 weeks
twp types of tx for fibroids?
hormonal: OCPs/IUD/GnRH agonists
nonhormonal: NSAIDs
palpable uterus above symphysis pubis sx of what?
** enlarged, asymmetric, nontender uterus
possible fibroid
Which of the following would increase the chance of intrauterine device expulsion or failure?
< 25 y/o
prior explusion
hx of menorrhagia or severe dysmenorrhea
postpartum or post-second trimester abortion
what week is it considered PPROM?
< 37 weeks
when is mag considered apart of the PPROM treatment?
when it occurs < 32 weeks (provides neuro protection)
test to distinguish between false labor & increased risk of preterm labor when membranes have not ruptured?
fetal fibronectin
Downward displacement of the anterior vaginal wall on speculum exam during Valsalva maneuver
cystocele
most accurate measurement of expected delivery date?
CRL
more accurate in early pregnancy (22+0 weeks)
cyclical pelvic pain
painful intercourse
abnormal bleeding
abdominal pain
infertility *
ovarian mass*
endometriosis
endometriosis triad
dysmenorrhea
dyspareunia
dyschezia
postpartum glucose screenin in women w/ GDM
FPG or 2 hour OGTT @4-12 weeks postpartum
if normal, repeat screening Q1-3 weeks
s/sx of multiple gestations
- increased morning sickness
- larger than expected fundal height
- excessive maternal weigth gain
- INC. bHCG & AFP
fixed mass & larger amt of fluid (ascities) on US??
c/f ovarian cancer/carcinoma
tumor marker for ovarian cancer (epithelial)
CA 125 (> 35 U/mL)
** benign conditions that can cause an elevated CA125 = endometriosis, fibroids, PID.
** CA125 > 200 requires oncology referral
more dominant form of estrogen in menopause that undergoes an increase?
estrone (E2)
** less potent estrogen
new onset HTN in < 20 weeks gestation?
suspect molar pregnancy or undiagnosed chronic HTN
preE delivery:
–x– weeks w/o severe features
–y– weeks w/ severe features
X = 37
Y= 34 (requires seizure prophy w/ mag sulfate)
when is it safe to preform an external version?
37 weeks
** always requires US prior to confirm orientation of fetus and location of placenta
when do you perform anti-D antibody screening?
initial visit, 28 weeks, delivery (w/n 72 hours)
wickham striae ??
s/sx of lichen planus
tx of asymptomatic rectocele?
observe w/ yearly examination
1st line chemo therapy for suboptimally cytoreduced disease in eputhelial ovarian cancer
Carboplatin
Paclitaxel
when do fibroadenomas typically regress?
after menopause (bc they are estrogen dependent)
TOC in hemodynamically unstable pt w/ heavy uterine bleeding?
uterine curettage
** if this does not work –> IV conjugated equine estrogen (in high doses can reduce heavy bleeding bc it stabilizes the endometrial lining)
1st line tx of PMDD
relaxation therapy & SSRI
2nd line = OCPs
counseling in twin gestations
- wt gain of 37-54 lbs
- prenatal vitamin during first tri
- additional iron, mag, zinc after first tri
- 1 mg folate & 1000 IU vitD
- sleep on left side during 2nd/3rd tri
what type of pregnancies can twin-twin transfusion syndrome occur?
monochorionic (share a placenta)
GTPAL
G = total # pregnancies
T = full-term pregnancies (37-40 wk)
P = preterm deliveries (20-36 wk)
A= abortion/miscarriage (< 20 wks)
L= living children
can proteinuria be normal in pregnancy w/o BP changes?
yes - 2/2 increased GFR
acid base disturbance 2/2 to vomiting?
hypokalemia, hypochloremic metabolic alkalosis
** starvation ketosis can occur 2/2 to decreased calorie intake
anti-emetic CI in pregnancy?
ondansetron (zofran) –> small risk of congenital anomalies
when is there a peak in hyperemesis gravidarum?
weeks 8-12
increased puslation felt at lateranl fornicies
oslander sign
1st tri
marked softening of the cervix
goodell sign
1st tri
asymetrrical enlargement of uterus in case of lateral implantation
piskacek sign
1st tri
upper part of uterus is enlarged w/ growing ovum & lower part is empty
hegar sign
1st tri
Naegele Rule
EDD: 1st day LMP + 7 days - 3 mo + 1 year
how long does PP blues last?
24-72 HOURS
“fixed uterus” is c/f ….
endometriosis
MC symptom of fibroids
heavy & prolonged menses
maternal RF for preterm labor
asthma
how early can molor pregnancy be detected on US
8 weeks
hetertopic pregnancy
one intrauterine gestational sac + one ectopic gestational sac
CI for labetalol use in PIH
asthma –> bc can cause bronchoconstriction
how long must elevatred BP persist postpartum to become chronic htn?
12 weeks
** if returns to normal by 12 weeks pp it can be classifed as transient
empiric tx for acute cystitis during pregnancy
- fosfomycin
- amoxi-clav
- cefpodoximine
** must always obtain test of cure for cystitis in pregnancy
what cystitis tx is commonly avoided during first trimester & at term?
nitrofuratonin
** possible fetal birth defects in first tri
** avoided 30 days before term to reduce possibility of neonatal jaundice
definition of REACTIVE NST
at least 2 accelerations in 20 min period
test with high negative predictive value for perterm labor
fetal fibronectin (measured from cervicovaginal specimens)
amniotic fluid ph on nitrazine test
ph > 7.0
critical maternal anti-titer titer level
1:16 or 1:32
** requires doppler velocimetry of mca to assess for fetal anemia
pap screening < 21 y/o
not indicated
pap screening 21-29
pap Q3 years (reflux HPV)
Pap 30-65
co-test (pap + HPV) Q5 years OR pap Q3 w/ reflux HPV
pap screening > 65 or s/p hysterectomy
no screening (if no hx of CIN 2+ in past 20 years)
guardasil vaccine schedule
Two doses (0,6-12 mo) if initiated between ages 9-14 y/o
Three doses (0,1-2, 6 mo) if initiated at ages 15
when is colpo indicated for abnormal pap results
if test shows (+) HPV w/ ASC-US, HSIL, LSIL or atypical glandular cells
when is colpo NOT indicated for abnormal pap results
ASC-US & (-) HPV
when is Leep used?
HSIL lesions
black box warning of tamoxifen [used in postmenopausal receptor (+) BC]
uterine maliganncy
thromboembolic events
Primary treatment of early-stage (stages I, IIA, IIB) breast cancer
lumpectomy or total mastectomy
** in hormone (+) BC hormone therapy is indicated after surgical interve
BC screening
mammo at 40-74 Q2 years in avg risk women
complication of loop electrosurgical excision for hpv ?
cervical insufficency –> second-tri miscarriage
Women with the BRCA1 gene mutation are more likely to be diagnosed with what form of breast cancer?
medullary carcinoma
most sig rf for BC
age
HPV that causes genital warts
6 & 11
sanguinous nipple discharge
papillary breast carcinoma (rare type of breast cancer)
what is rec in addition to colpo if pt does not have any lesions present on PE?
endocervical curettage
definitive dx of torsion
direct visualization at time of surgical evaluation
smoking cessation in pregnancy
- counseling is first line
- nicotine replacement is appropriate as adjunct
** can use bupropion & varnicline last line
MC organism in chorioamnionitis
ureaplasma urealyticum
tx w/ amp + gent
fetal membranes are held together by what proteins?
Collagen
Fibronectin
Laminin
pathogenesis of premature rupture of membranes
premature activation of a metalloprotease enzyme (which degrades collagen & decreases membrane strength)
etiology of enlarged, smooth uterus w/ irregulr shape
uterine leiomyomas
how is PID dx?
clinical findings (most commonly)
when is cerclage placed in cervical insuff?
CERCLAGE PLACEMENT @ 12-14 WEEKS
WOMEN W/ CERVIX < 25 MM
cervical insufficency prophylaxis?
hydroxyprogesterone between 16-36 weeks
***if hx of cervical insufficiency and is a singleton pregnancy
** in twin gestations just do expectant mgmt
PE presentation of cervical intrapeithelial neoplasia?
cervix is normal appearing on PE w/o noticeable suspicious lesions
** really only found on pathology of colpospy
** if lesions are present –> cervical carcinoma (aka scc 2/2 HPV infx)
What is the first visible sign of puberty in girls between 8 to 12 years of age and the hallmark of Tanner stage 2?
breast buds
characteristics of trisomy 18 (edward syndrome)
- clenched fists
- rocker bottom feet
- hypoplastic nails
- prominent occiput
- low set ears
- horse shoe kidney
trisome 13 (patau) syndrome charc
- micro or anophthalmia
- cleft lip or palate
- postaxial polydactyly
trisomy 21 on US
- thickened nuchal fold
- duodenal atresia
- CVD abnormalities
what gestationala ge can you perform an amniocentesis?
15 weeks
tx of nedometrial cancer in women who desire fertility?
trial of progestin therapy (megestrol acetate)
other candidates for fertility-sparing progestin therapy include women d
** surgical therapy after pt no longer wants children
Rf for primary dysmennorhea
age < 30 y/o
menarche before 12 y/o
tx of HER2 + BC
trastuzumab + chemotherapy
tx of ER + BC
Tamoxifen
MOA: SERM
common tx in infiltrating ductal carcinoma (BC)
breast-conserving: lumpectomy + radiation
non-conserving: masectomy + radiation
** should do sentinel lymoh node biopsy as well
can uterine atony present hours after delivery?
yes, can present even up to 12 hours after delivery
tx of TOA (even if hemodynamicailly stable)
admission + IV abx [+/- surgical drainage]
SSRis safe in breastfeeding
paroxetine
sertraline
citalopram
** if mild-mod depression in postpartum period –> CBT is 1st line therapy
RF for placental abruption
astham
hypertension
previous abruption
typical ultrasound findings of placental abruption
retroplacental hematoma
lab findings in placental abruption
fibrin level </= 200 mg/dL
[aka consistent w/ DIC which is MC complication of placental abruption]
PE findings in vulvar cancer?
white lichenified & adherent 2-3 cm plaques on bilateral labia minora
** uncontrolled lichen sclerosis can lead to vulvar cancer
urethral caruncle
friable, bright red, small papule at urethral meatus
** meds indicated when they cannot control sugars despite LSM
1st line tx for GDM
lifestyle modifications & self-monitoring glucose
additional fetal monitoring in GDM
if on medications :
- beg 32 wks: 2x/wk NSTs & amniotic fluid index
despite medications:
- US @ 36-29 weeks to assess fetal weight (to assess dystocia risks & need for csection)
