Common Medical Complications in Pregnancy. Susan M Cox, MD 4.27.2014. Milestone 1. Basic understanding of the pathophysiology and management of gestational hypertensive diseases Basic understanding and management of Diabetes Mellitus complicating pregnancy. Objectives.
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Susan M Cox, MD
Complicates 8% of pregnancies
Deliver the baby!
Dexamethasone not effective
(Am J of Obstet Gynecol 2005 Nov; 193(5):1591-1598)
100 gram glucola (3 hr GTT)
identify only 40-60% of cases of GDM
Fifth International Workshop Conference on GDM certain features place women at low risk of GDM, and it may not be cost-effective to screen this group of women. Represents only 10% of population.
A positive test for GDM is 2 of 4 values abnormal
Fasting < 95
One hour PP < 130
Two hour PP < 120
1. No difference in maternal / neonatal outcomes
34-year-old G4 P3 at 19 weeks presents to the emergency department with chest pain, palpitations and sweating, which began 4 hours ago. She notes that she has been very anxious lately and is not sleeping well, which she attributes to the pregnancy. She reports that she has lost 30 pounds in the last year while not dieting. She denies significant medical problems.
Examination: patient appears diaphoretic and anxious, her eyes are wide open, prominent, and you can easily see the sclera surrounding the pupil. Her temperature is 38.1; pulse is 132; and her blood pressure is 162/84. Height is 1.75 meters (70”) and weight is 58 kg (128 lb.). Her thyroid is palpably enlarged, with an audible bruit. Electrocardiogram shows sinus tachycardia. Remaining labs are pending.