Obstetrics [THIRD TRIMESTER LABS]

Gestational Diabetes
Everyone gets tested for gestational diabetes. Risk factors
include advanced maternal age, preconception obesity, and Screen: 1 hour glucose tolerance test
being "fat for pregnancy" which is >1 pound / week gestational - Positive > 140 = go to 3-GTT
gain. This is important, because there are crucial differences in - Negative < 140 = stop screen
screening patients for diabetes in medicine and in obstetrics.

NO screening with hemoglobin A1c. The A1c is an average of Confirm: 3 hour glucose tolerance test positive if:
the past 3 months' sugar level. In order to be diagnosed with - Fasting > 95
gestational diabetes, the diabetes must occur after week 20, and - 1 hour > 180
therefore, the preceding 12 weeks would have normal sugars, - 2 hour > 155
and a normal A1c. - 3 Hour > 140

BUT... if fasting > 95, that's good enough and no 3-GTT needs
NO screening with the 2 hour glucose tolerance test
to be performed.
NO screening with fasting glucose.

In obstetrics you use the 1 Hour Glucose Tolerance Test (1-

GTT) followed by the 3 hour Glucose Tolerance Test (3-
GTT). The first step is to feed the woman a 50g oral glucose
load, check her sugar at 1 hour. If it is > 140 she has screened
positive and gets the 3-GTT. If it is < 140, she has no
gestational diabetes, and she is good to go.

If positive on any two values, treat with insulin.

Anemia
Both the protein and the serum component of mom's blood Nadir at 28-30 weeks
increases. It happens that the plasma increases more than the
protein. Which means that, since hemoglobin is a concentration, Abnormal < 10
there is more water and less stuff. Women are expected to
become anemic. That is, the hemoglobin is low. However, they
actually have an INCREASED oxygen carrying capacity and a
RESERVE of red blood cells. And so it is not surprising then,
that a woman's hemoglobin falls. The nadir is at 28-30 weeks
and should never go below 10. If it is below 10, something is
the matter. Most often it is an iron deficiency anemia. If found
to be abnormal a more thorough evaluation of anemia is
required. See the medicine lectures for the workup of anemia.

Abnormal Antibody Screen, Rh typing

This topic comes up in greater detail in its own dedicated
lecture. What we want to do is prevent an Rh negative mom
from identifying Rh positive babies as foreign. We do this on all
Rh-negative mom's. What we test for is the Rh-IgG-Antibody.
If it is positive, it is too late, and mom's immune system has
already been primed to attack Rh-Antigen-Positive baby. If
negative AND dad is Rh+ or Unknown, we protect mom from
developing antibodies against the Rhesus Antigen by giving
Rhogam.
Screen Rh-Antigen-Negative Moms for Rh-Antibody
If dad is Rh-Antigen-Unknown OR Rh-Antigen-Positive
AND
Mom is Rh-Antigen-Negative and Rh-Antibody-Negative
THEN
Rhogham at 28 weeks and delivery

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