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IN THE NAME OF GOD

IN THE NAME OF GOD. PANEL DISCUSSION. DIABETES SCREENING IN PREGNANCY. Panel Discussion Laleh Eslamian MD, Prof of Obstet & Gynecol , Perinatologist , Shariati hospital, TUMS. Screening for Gestational Diabetes.

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD PANEL DISCUSSION

  2. DIABETES SCREENING IN PREGNANCY Panel Discussion LalehEslamian MD, Prof of Obstet & Gynecol, Perinatologist, Shariati hospital, TUMS

  3. Screening for Gestational Diabetes • Population: all pregnant women. • Recommendation: Screen @ 24-28w Screen high risks @ 1st prenatal visit if normal repeat @ 24-28w • Screening tests: 2 step:50g GCT, measure BS @ 1h(ACOG) 1 step:75g GTT, measure FBS & BS @ 1h &2h(IASPDG, WHO) • Interventions: 2 step, if 1h BS>140mg/dl: perform 100g GTT 1 step, ≥ 1 abnormal value = GDM • Benefits of detection & early Tx: Reduces macrosomia, preeclampsia, CPD , birth trauma & C/S.

  4. Most commonly used guidelines for Dx of GDM

  5. International Association of Diabetes in Pregnancy 2010 • Everybody @ 1st visit have either: 1)FPS ≥ 5.1-7mmol/L(92-126mg/dl): Dx of GDM 2)Random plasma glucose> 11mmol/L(198mg/dl): need OGTT 3)HBA1C>6.5: need OGTT • Everybody @24-28w OGTT

  6. HIV INFECTION & PREGNANCY Panel Discussion

  7. HIV infection • Medical care of HIV-infected pregnant women: favorable maternal health outcomes & low rates of perinatal HIV transmission. • Screen for anemia, HBV & HCV infections. • Maternal viral load> 1000 copies/ml near term: CS @ 38w to reduce perinatal HIV transmission. • Intrapartum , Tx with zidovudine depends on maternal plasma viral load. • Breastfeeding is not recommended.

  8. OBESITY & PREGNANCY Panel Discussion

  9. Obesity • BMI ≥ 30kg/m2 • Compared to BMI<25: APO. • 1st trimester screening for diabetes. • Early US for determining GA & multiple gestation. • Additional counseling & monitoring( diet, exercise, weight gain). • 2nd trimester US: more difficult because of adiposity.

  10. Obesity (continued) • Obesity alone is not an indication for fetal surveillance. • Obesity alone is not an indication for induction of labor. • Anesthesia consultation. • Consider VTE risk factors: @ CS or immobility. • Modify surgical techniques for adequate exposure.

  11. ADDICTION & PREGNANCY Panel Discussion

  12. Illicit drug use in pregnancy (overview) • Identification & Tx: maternal drug use. • Most practical screening method: asking specific Qs. • Risk factors: late initiation or multiple missed prenatal visits, past APO, neurodevelopment or behavioral problems in children, children not living with mother &……. • Women dependent on opiates: opiate substitution therapy with methadone. • Cocaine: VC of uterine vessels leading to abruptio placenta, abortion, prematurity & fetal death.

  13. REPEAT CESAREAN DELIVERY Panel Discussion

  14. CESAREAN REPEAT DELIVERY • Timing • Preoperative issues: 1) Informed consent( injury to viscera, transfusion & cesarean hysterectomy) 2) Evaluation for placenta previa/ accreta 3) Anesthesiologist consultation • Operative issues: Opening the abdomen, bladder flap, hysterotomy, …. • Long term complications: Hernia, diastasis, CS scar pregnancy, endometriosis, skin numbness

  15. Risk of complications associated with CS according to the number of previous CS(%)

  16. Risk of placenta previa & accreta according to number of previous CS

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