GDM, Focus on criteria, management, when to deliver, lab tests and values , follow up tests
including tests after delivery and when those tests are taken
Common malformations if mother is GDM.
Think of organ most affected in fetus if mother
has GDM
Management for px with GDM
Prenatal screening for GDM
If FBS <92, when do you screen and why do
you screen again
Patient was managed for atony, the uterine
was contracted but a sudden gush of blood
was noticed. What should you suspect?
Patient underwent CS for dystocia, +
lacerations from incision, bleeding was
profuse even with uterotonics, next step to
do?
During hemorrhage , what vital signs are
most important to look out for during
hemorrhage?
Capillary blood glucose =90-100mg/dl
2hOGTT, when should you deliver?
In a patient with GDM, which is the first line
pharmacologic agent?
How often do you do glucose monitoring for
GDM
What is the chance of development for overt
diabetes from GDM after 20y
GDM patient with controlled BP was asking
for birth control, which is best to give.
Cardiac problem
First line: dietary modifications, refer to
dietician
If px is diabetic > 92 FBS -> refer to
endocrinologist for management, may also be
referred to perinatologist
FBS -> 75 OGTT
24-28wks AOG
Asians are at high risks of DM
Presence of lacerations in either
cervix/vaginal wall//periurethral area -> may
lead to DIC -> so suture
If no lacerations, it may be perforation in the
uterus (uterine rupture) or placental
fragments (if uterus is big and bleeding)
Uterine artery ligation
(hysterectomy should be the last option)
URINE OUTPUT as it is most reflective of
perfusion
39 wks because patient has good control
If poor control -> 38wks
Insulin
4x daily
50% ( review)
Progesterone only pills if the patient is
breastfeeding after 2mo
You have to wait for 2mo or 6wks to start pills
because pregnancy is a hypercoagulable
 state and pills can contribute more to that
state

(Check williams regarding COC)

Immediately postpartsum, patient had Uterine atony (TONE under 4Ts)

postpartum hemorrhage, uterus is soft and
boggy. What is the diagnosis

Which women are most susceptible to PPH Smaller weight women

Multipara

Which uterotonic agent can cause tetanic Ergots -> careful in pxs with high BP
uterine contractions when given IM

Can you give carboprost to asthmatic No

patients?

Most common side effect of carboprost Diarrhea

In case of uterine inversion, what is the Stop oxytocin -> give terbutaline (to relax
immediate management uterus)-> reposition or manual rotation ->stop
terbutal restart oxytocin

What dilatation is active labor considered? 6cm

When do you consider a prolonged latent >20h

phase for nulliparas?

Primi patient , at 38wks AOG, came in for First stage labor

labor pains, low risk, CTG CAT 1, MVU 200.
What stage of labor

Cervical dilatation, 8cm for >3h, amniotomy Prolonged deceleration phase

done showing pale stain –. What is the
abnormality of labor

Remember different criteria for inlet, midpelvic, outlet; interischious pila ka cm and etc

30 y.o nullipara 7cm dilation, 80% effaced, Secondary arrest of dilatation

station -3 for >3 h MVU:250. What is (always base it on definitions)
diagnosis

What is the expected rate of dilatation >1.2cm/h nulliparas

>1.5cm/h multipara

Common complication in prolonged Uterine atony -> POSTPARTUM

augmented labor HEMORRHAGE(bc uterine receptors of
oxytocin will be tired)

36y/o G6P2 w/ chronic hypertension, overt Cesarean section due to footling breech and
diabetic, with poor compliance of 110 fetal heart rate
medications, fetal kick counting <10, BP
180/100, Fundal height 45cm, Fetal heart
tone is at 110 BPM, came in for footling
breech presentation, already in labor,
management?

Naa toy fluid something Expected management

Precipitate delivery, how rapid is the labor? <3h

Danger: heavy bleeding secondary to uterine
atony *maternal complication*
Neonatal asphyxia

41wks AOG, 4cm dilatation >24h, category 1 Augmentation of labor (bc she is already at
, MVU 100. What is the management 41wks)

How should you manage hypotonic uterine Uterotonics -> Oxytocin (1st line)
contractions? 2nd line :methergine

Commonly used hysterotomy *uterus* Low segment transverse incision

incision in C/S.

Commonly used laparotomy *skin* incision Pfannenstiel incision

Placenta previa anteriorly implanted. What is Classical incision (incise at upper part)
the incision?

Most common cause of PPH Uterine atony

G8 woman, 40 wks AOG,prolonged labor Uterine rupture

with unstable vital signs: pale, hypotensive,
tachycardic ,abdomen tender and
irregular.No fetal heart tones. What is the
diagnosis?

<8cm: arrest disorders

8-9cm: prolonged deceleration phase
10cm: descent problem bc fully dilated already

Most common complication of giving too Severe Hypotension and cardiac arrhythmias
much oxytocin