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3rd Tri Labs (Gestational Diabetes: GDM (Path: Diabetes :candy: that…

- - - - Pt: :pregnant_woman::skin-tone-2:RF's
        
        BMI > 30
        
        Hx of GDM
        
        Prediabetic moms (insulin insensitivity)
        
        :pencil2:These RF's can indicate earlier screening (before 20 wks), but generally still follow guidelines 20-26wks screen
        
        :pencil2:Differences btw Diabetes in OB vs. IM
        
        ~~Dx w/ A1c~~
        
        only good for past 90 days,
        
        won't see rise in BG if normal in 1st Tri
        
        ~~2 hr glucose tolerance~~
        
        old test prior to A1c for general DM screening
        
        Dx:
        
        1hr glucose tolerance test
        
        Asx screen:
        
        50g glucose = :check: if ≥140mg/dl 1 hr after load given
        
        (if :check: & too high)
        
        3hr glucose tolerance test (f/u test: 100g glucose measuring 4 different values
        
        Fasting: >90
        
        1hr: >180
        
        2hr: >155
        
        3hr: >140
        
        Any 2 elevated = :check: positive test)
        
        Tx: Insulin (only right answer)
        
        target postprandial sugars
        
        goal < 180
        :pencil2:in practice, orals are now being used
        
        :pencil2:Compare to IM approach
        
        goal <120, targeting preprandial sugars
- - - - Dx: Rh Antibody test
        
        Rh Antibody (+)
        
        too late and can't do anything about it
        
        concern for fetal anemia
        
        Father :man::skin-tone-6: must have been Rh(+)
        
        & during this pregnancy… :pregnant_woman::skin-tone-2:had Rh Antibody (+)
        
        & had sufficient titers to be problematic
        
        & right type to cause a problem
        
        Dx: Transcranial Doppler
        
        to assess for anemia
        
        can do a PUBs (baby transfusion), but mostly you should…
        
        just deliver
        
        Rh Antibody (-)
        
        goal: protect the immune system so Ab will never attack future child
        
        Baby might be Rh (+) or unknown Rh status
        Tx: Rh (D) immunoglobulin: Rhogan @ 28 wks and w/in 72 hrs of "delivery"
        
        "Joe" Rhogan: Ab against the Rh antigen (hides it from mom's immune sys)
        
        :pencil2:Delivery means anytime there might be maternal fetal blood mixing
- - - - Lower than 10? Possible IDA
        :warning:This should be your reflex assumption
        
        Pt: Asx screen @ 28wks
        
        CBC w/ Hgb
        
        Dx: Hgb < 10 or hematocrit < 30
        
        Iron studies
        
        Ferritin low
        
        MCV very low
        
        RDW elevated
        
        Tx: Iron (Fe)
        
        :pencil2:: Folate is supplemented for NTD. Rarely its the cause of Maternal anemia. Think IDA, not folate in Anemia