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Case study #1: Mrs. C
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Mrs. C.
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Mrs. C
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Mrs. C
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Mrs. C
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Mrs. C
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Mrs. C
Her insulin dose has stabilized
NPH 8 units at bedtime
rapid acting insulin 6 u before breakfast, 4 units before lunch
and 4 units before evening meal.
Mrs. C goes into labour at 39 weeks.
Should she have been induced earlier?
Should a C-Section be considered?
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Mrs. C
Following delivery, blood glucose levels normalised and
she was able to stop insulin.
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Case study #2: Mrs. S
Mrs. S is a 35 year old nulliparous lady and has suffered
two miscarriages in the last three years.
She did not test her blood glucose levels during either of
her previous pregnancies.
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Mrs. S
Mrs S has an OGTT at 13 weeks gestation
Fasting 2 hour
Glucose 6.0 (108) 9.0 (162)
mmol/L(mg/dl)
No family history of DM
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Mrs M
Fasting BG at 6 weeks
Fasting
8.8 mmol/L (160 mg/dL)
What risks to the pregnancy will you discuss with this lady?
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Mrs M
Normal scan at 12 weeks with a low risk of Downs
19- 20 week scan plus fetal echo was normal
When will you advise next scan?
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MRS M Blood glucose record
Gestational FBS mmol/L 1 h PPBS A1c Medication
age (mg/dL) mmol/L(mg/dL) %
15 5.9 (107) 6.9 (125) 8.1 Premix 70/30
18 - 0 - 18 +
Metformin
500 BD
18 7.1 (129) 10.1 (183) 7.2 22 - 0 - 22 +
Metformin BD
19 5.3 (97) 9.6 (173) 26 - 0 - 20 +
Metformin BD
5.8 (105) 8.7 (157) 6.5
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Mrs M
29 week scan
Ask to comment
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Mrs M
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Mrs M
Tocolytic which drug and dose
Steroids dose / concerns in GDM
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Mrs M
Uterine contractions settle. UTI picked up and treated with
appropriate antibiotics
She is now 37 weeks
FBS 5.5mmol/L (100mg/dL) 1 hr PPBS 8.3 mmol/L (150
mg.dL) on
Regular (soluble) 26-10-14 + NPH 0-0-12
Comes in with decreased movements
What would your approach be?
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Case Study #4
Mrs. C, a 32 year old primigravida
Reports for the first antenatal checkup.
She is obese with a body mass index of 35 kg/m2, both her parents
have diabetes.