Ebook Case files – High risk obstetrics: Part 2
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Ebook Case files – High risk obstetrics: Part 2
https://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2ellitus. She regularly sees an internist who manages her diabetes and general medical care. She has been treated with multiple oral hypoglycemic medications in order to achieve appropriate glycemic control. Her current regimen includes glyburide which she has taken for the past year and metformin wh Ebook Case files – High risk obstetrics: Part 2ich was added 6 months prior to improve her level of glycemic control. She denies hypertension, retinopathy, and renal disease. Her obstetric historyEbook Case files – High risk obstetrics: Part 2
is significant for two first trimester pregnancy losses occurring 1 and 3 years prior. The patient and her husband are contemplating a pregnancy; howehttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2is patient?>What are potential maternal complications of diabetes mellitus in pregnancy?>What are potential feral complications?>How would you counsel this patient in terms of pregnancy planning?>How would you manage her if she became pregnant?212CASE FILES: High-Risk ObstetricsANSWERS TO CASE 19:Pr Ebook Case files – High risk obstetrics: Part 2egestational DiabetesSummary: An essential nulliparous with a personal history of diabetes and multiple pregnancy losses presents for preconception coEbook Case files – High risk obstetrics: Part 2
unseling.>First step in evaluating this patient: A detailed history and physical examination including baseline laboratory testing should be completedhttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2s not occur until diabetic control is optimized.>Potential maternal complications of diabetes mellitus in pregnancy: Women with diabetes who become pregnant often experience less stable glycemic control. They are also at increased risk of chronic hypertension, preeclampsia, diabetic retinopathy, and Ebook Case files – High risk obstetrics: Part 2 cesarean delivery-.>Potential fetal complications: Diabetics with suboptimal glycemic control have higher rates of pregnancy loss birth defects, pretEbook Case files – High risk obstetrics: Part 2
erm delivery, disturbances in fetal growth, and stillbirth.>Counselling this patient in terms of pregnancy planning: The patient should be counseled thttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2in neonatal morbidity and mortality rates similar to the general population.>Management plan in case of pregnancy: She should receive frequent physician visits in order to monitor glycemic control. She should receive ophthalmologic evaluations every trimester and during the postpartum period. She sh Ebook Case files – High risk obstetrics: Part 2ould receive a detailed anatomy ultrasound and potentially a fetal echocard iogram during the second trimester. Fetal surveillance should be achievedEbook Case files – High risk obstetrics: Part 2
with antenatal testing and serial growth ultrasounds. If glycemic control is optimal, delivery- should occur between 39 and 40 weeks’ gestation. Womenhttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2tational diabetes on the pregnancy.2Describe the management of pregestational diabetes.3List the complications that may occur to a pregestational diabetic duringCLINICAL CASES213ConsiderationsDiabetes affects approximately 8 million women annually and complicates approximately 1% of all pregnancies. Ebook Case files – High risk obstetrics: Part 2 Progestational diabetes accounts for approximately 10% OÍ insulin resistance encountered in pregnant women with the larger share being owed to gestatEbook Case files – High risk obstetrics: Part 2
ional diabetes1 (Level III).The most important aspects oi managing women with diabetes who become pregnant should occur prior to conception. These womhttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2n their baby. Women with suboptimal diabetic control should be counseled in terms oi appropriate contraception in order ro ensure that conception occurs only after appropriate control has been established.Preconception counseling should include a detailed history and physical examination in order to Ebook Case files – High risk obstetrics: Part 2 assess rhe severity of their disease as well as their level of glycemic control. Initial laboratory tests should include measurements of glycosylatedEbook Case files – High risk obstetrics: Part 2
hemoglobin (HbAk), thyroid-stimulating hormone (TSH), screening for creatinine clearance and urinary protein excretion, complete blood count, and a bhttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2atus arid severity of disease prior to pregnancy in order to make plans regarding riming of pregnancy and appropriate surveillance. Second, women with chronic health condition such as diabetes are at risk of other comorbid conditions which may affect maternal and neonatal outcome. All progestational Ebook Case files – High risk obstetrics: Part 2 diabetics should have ophthalmologic examinations prior to and during pregnancy. The frequency of surveillance can be based on the degree of retinopaEbook Case files – High risk obstetrics: Part 2
thy. Those with chronic conditions such as hypertension and hypercholesterolemia should receive appropriate evaluations such as ECG and echocardiogramhttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2s (ACE-1) should be discontinued prior to conception. Oral hypoglycemic agents can be discontinued during rhe first trimester if glycemic control is optimal based on I lbA)(.. Insulin treatment can be started based on glucose monitoring. Alternatively, if rhe patient’s glycemic control is subopti-ma Ebook Case files – High risk obstetrics: Part 2l on oral hypoglycemic agents, she can be switched to insulin immediately.APPROACH TOPregestational DiabetesThe previously used White classification wEbook Case files – High risk obstetrics: Part 2
as devised to classify diabetes based on rhe duration of disease and rhe presence or absence of end-stage organ disease. One of the main utilities of https://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes me Ebook Case files – High risk obstetrics: Part 2and maternal prognosis has greatly improved, this system has proven to be less useful. The classification system that most physicians currently use classifies insulin resistance based on whether the physiology is due to p-cell dysfunc-tion resulting in an absolute insulin deficiency as is seen in ty Ebook Case files – High risk obstetrics: Part 2pe 1 diabetes or due to insulin resistance and relative insulin deficiency as is seen in type 2 diabetes2-4 (Level 111). Additional information shouldEbook Case files – High risk obstetrics: Part 2
be provided concerning diabetic complications. This classification scheme relates outcomes to the degree of metabolic control and thus better directshttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes mehttps://khothuvien.cori!Case 19A 30-year-old G2POO2O presents to the office tor preconception counseling secondary to an 8-year history of diabetes meGọi ngay
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