[OBGY. 02] Gestational Diabetes with case study



hi today we will be reviewing gestational diabetes so by definition just a tional diabetes is any degree of glucose intolerance that is first recognized during pregnancy it's important to note that it's first recognized during pregnancy so any diabetes that is diagnosed before pregnancy is not deemed as gestational diabetes so it is mentioned in the textbook that pregnancy normally increases insulin resistance because of certain placental hormone that increases the insulin tolerance including the growth hormone corticotropin-releasing hormone which is c rh placental oxygen and progesterone all contribute to the increase in glucose intolerance that those patient especially gdm patient is who has pancreatic insufficiency that means the pancreas cannot tolerate I mean Congress cannot Secret Angel in enough in order to tolerate those glucose intolerance that is given by pregnancy then those patient as well become gestational diabetes because you cannot deal with that glucose in Taurus with sufficient insulin release the risk factor than for a gestational diabetes will be as follows severe obesity and family history of t2 diem previous gdm impaired glucose metabolism glycosuria at first prenatal visit and multiple gestation and even maternal age shows over 25 years old of age so personal history of impaired glucose tolerance or gestational diabetes and a previous pregnancy is one important factor and any medical condition were studying that is associated with development of diabetes itself so actually the risk factor quite oval overlap with the risk factor for diabetes so such as metabolic syndrome polycystic ovary syndrome which we call as PCOS and current years of glucocorticoids and hypertension with all contribute as risk factor for developing gdm and since busily here is mentioned as risk factor for developing gdm lowering weight is proven to decrease the risk for gdn so how do you screen gdm so as you have seen the risk factor there is low risk patient and every risk patient and high risk patient so low risk patient does not really need routine screening but if the patient seems to have average risk which means that normally the patient would go through a routine screening at around 24 to 28 wait with 50 gram Gold Coast loading at fasting state so if when given 50 gram of glucose at fasting state if the patient shows glucose level of more than higher than 140 milligrams per deciliter then it means the patient should be done more tests we should run that doctors should run more tests in order to see if she the patient is really gdm or not so after screening there is a to the screening can be done in two steps or even one step then once the procedure is screening and diagnosing at the same time so what I have told you before is screening in 50 gram Audrey TT is screening and then if it's deemed positive in the screening then the patient should go through 100 gram Audrey TT or it can be done in one step which is 75 gram lgt T so if you are as a doctor if you're suspicious that the sub patient may have gdn because he has a high risk like the family history or previa impaired glucose tolerance while pregnancy then do not be assured that by just one test and the doctor recommended to repeat blue clock blue blood glucose test between 24 the 28th week or if you think there is a suggestive symptom of glucose intolerance so diagnosis is done under this criteria so it differs between 100 gram or GTT and 75 gram or GTT and 100 gram or GTT requires the doctor to measure the blood glucose level for time is fasting one hour two hour and three hour but 7500 GTT the doctor has to check blood glucose blood glucose level for three times so if in 100 lgt t if there is more than two abnormal results than its deemed positive that in 75 gram or GT t one abnormal result may mean that the patient is actually G DM so G DM is important because the doctor should note doctor can note its complications can foresee complications and can help patient by preventing those complications those include critical mca Hydra is macrosomia this as one complication that is very well known because high glucose level is high insulin level which will make the baby very large for a desk gestational age and feet or Grandda Magali may be one part of macrosomia and maternal infant birth trauma because the fetus the baby will be very big at birth and primary cesarean delivery that's pretty frequently John for a G DM patient and preparing at home we're told he is higher for a Julian patient and is it is that that there is more stillbirth babies that is born under G DM patient and you neato hypoglycemia is another a complication because the fetus will be chronically exposed to high glucose level inside the uterus and may may secrete more insurance so the fetus will have pancreatic hyperplasia but then when after birth the fetus cannot get all the glucose from mother but the fetus is very familiar with the environment where in the glucose comes out a lot and the fetus and I mean the baby after birth secrets a lot of insulin even when there's no glucose so that's why the fetus falls into I mean the baby falls into hypoglycemia and it's supported to note that there is no evidence the fetal abnormalities increases with gdm well long term complications not only includes type one or two the actual diabetes not gestational diabetes but also includes include increased risk for developing cardiovascular disease and offsprings may also have higher risk of obesity glucose intolerance metabolic syndrome and autism so how do you manage gestational diabetes so in order to manage the glucose level the patient should have diabetic diet that is indicated here and also should monitor ketonuria in order that the Ketan does not affect fetus in an adverse way and exercise is proven to improve glucose intolerance and glucose monitoring as essential and gdm patient and the mainstay of treatment is actually ensuring and usual is therapy should be started under the following criteria actual there's no set criteria for starting insulin therapy these are just in the guideline and it's it's interesting to note that the usual medication that is given to usual DM patient which is oral hypoglycemic control that bromine we're glyburide they are not recommended to the G DM patient and it's from literature is not for me is really bright or oral hypoglycemic control agents does not better result than insulin therapy so insulin therapy is recommended for G DM patient and at delivery literature says that the G DM patient can be induced can have induced delivery at a certain time but usually because of fetal macrosomia G damn patient usually goes through cesarean section so at labor it's important to check the maternal glucose level regularly since intra-party maternal hyperglycemia leads to an adverse neonatal outcome and it's also important to prevent unit or hypoglycemia for the reason I have told you before is a pancreatic hyper pancreatic hyperplasia and if glucose level is over 120 a minute every insulin that it differs from guideline to guideline some guidelines suggest higher criteria that it's it's better to monitor the glucose and even after delivery the doctor should check glucose level from in like 24 to 70 hour to see that the patient is recovering from hyperglycemia after delivery there might be free ways for the patient one way is that the patient may be diagnosed with actual DM and then the patient may go through DM treatment and another patient might have glucose intolerance but not to the point that it is diabetes then they should be monitored and they should go through dietary management and exercise so that it does not develop into actual diabetes and no normal patient if the patient is deemed normal then the patient should be worried about the future future risk of diabetes and the patient should always be assessed for their glucose intolerance because there is for diabetes for GT a patient there's higher risk of developing diabetes afterwards so the patient is usually usually checked six within six to twelve months after delivery to see if the patient is recovering or as it has actually developed diabetes we're going for glucose intolerance there is an interesting literature that says breastfeeding may decrease their long-term risk so as a doctor you could recommend breastfeeding mmm and it's important to follow-up the patient in the long term and reassessment is in the guideline it says it's every three years but I think it is up for the patient and the doctor to manage how frequently they want to get they want to be checked so I had prepared a short case study it's the information in this case study has been modified and with fire so if you are a medical student preparing for a case study this is not the format you should follow so the patient has 29 year old female who is pregnant first there's seven weeks plus 3 days and she has came she has come to the hospital complaining abdominal pain previously she has given birth to 4.46 kilogram male at 38th wake of her pregnancy in her first pregnancy for Caesar in Section two years ago what is of note here is that she has a family history of the in her mother's side and her vital appears stable and in her laboratory result although she has although the possible might have fun a lot lots of other laughs including CBC's were even infectious studies because she has complained abdominal pain but she either have any infection where any abnormality in lecture electrolytes or CBC's but she had high fasting glucose and hba1c again proved that she has high glucose so Dyna stick plan is confirming that she is G DM she may be G DM so the doctor has runs 75 gram Audrey TT because I'm usually the it starts with screening process but at this time it's highly suspicious so the doctor might have wanted to run the 75 gram of g TT for the purpose of screening and diagnosing and it obviously shows that it's going over every point of reference so it's obviously G DM the patient has been diagnosed with G DM and the treatment as I as I have told you is easily so she has been prescribed enjoyed because the fetus was big enough the patient had gone through cesarean section although it does not really exceed four point five kilogram criteria but still cesarean section was done and she has given to four point three color brown male and she has planned to be assessed her glucose level or her glucose intolerance in six to twenty weeks after her delivery years of reference and thank you for watching this video

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