Quote:
Originally Posted by phenobarb  q1: serum glucose level at 1 2 and 3 h are not presented but if markedly elevated i think iH insulin is the choice.
q2: mag sulf. |
1.The answer is A!! Unless a person is a member of a low-risk group,screening for gestational diabetes should be carried out in all pregnant women. Low-risk patients forgestational diabetes include those 25 years of age, with a body mass index 25 kg/m2,no maternal history of macrosomia or gestational diabetes, no diabetes in a first-degree relative, and not members of a high-risk ethnic group (African-American, Hispanic, or native American). If a patient has an elevated 1-h glucose level after taking 50 g of oral
glucose, then a 100-g challenge should follow. If elevated values of serum glucose arenoted at either the 1-, 2-, or 3-h time point, measures to control the gestational diabetes should be undertaken. Those with gestational diabetes are at an increased risk of preeclampsia, delivering infants who are large for the gestational age, and birth lacerations.
Dietary measures are usually sufficient to control most patients with mild gestational diabetes. However, those who cannot maintain fasting serum glucose concentrations 5.8 mmol/L (105 mg/dL) or 2-h postprandial glucose concentrations 6.7 mmol/L (120 mg/dL) should be treated with insulin. Oral hypoglycemic agents are contraindicated in the treatment of gestational diabetes. Importantly, those women in whom the
diagnosis of gestational diabetes is made should be followed in the postpartum period for the development of type 2 diabetes, which is common in such patients.
2.The answer is B!!!
Although preeclampsia is associated with abnormalities of circulatory autoregulation, the precise factors causing this syndrome are unknown. Preeclampsia is defined by the new onset of ypertension, proteinuria, and pathologic edema in a pregnant woman. It occurs in 5 to 7% of all pregnant females. Risk factors for the development of preeclampsia include first pregnancy, diabetes, renal disease or hypertension, extremes of maternal age, obesity, factor V Leiden mutation, angiotensinogen gene
T235, antiphospholipid antibody syndrome, and multiple gestation. The patient in the question has severe preeclampsia, which may be manifested by central nervous system dysfunction (headaches, blurred vision, seizures, or coma), marked elevation of blood pressure, severe proteinuria (5 g/24 h), renal failure, pulmonary edema, hepatic injury, thrombocytopenia, or disseminated intravascular coagulation. Since preeclampsia resolves within a few weeks after delivery, rapid delivery should be the most appropriate goal. For those women with severe preeclampsia, delivery should be accomplished after 32 weeks’ gestation, which balances the risk to the mother and the fetus. In the meantime, the blood pressure should be controlled carefully without great swings, which would inimize blood flow to the fetus. Angiotensin-converting enzyme inhibitors as well as angiotensin-receptor lockers should be avoided in the second and third trimesters of pregnancy because of their potential adverse affects on fetal development. The drugs of choice are intravenous labetalol or hydralazine. Calcium channel blockers are a reasonable alternative. While magnesium sulfate is the treatment of choice for prevention of eclamptic seizures, this drug should probably only begin once the decision to proceed with delivery has been made.
A 30-year-old Hispanic woman -
24-09-2006, 06:10 AM
Linear Mode
