| Author | 16 Posts |
patpelletier
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Found this question and I am not sure about the answer:
RITHU,expectant mother with 17 weeks pregnancy has come for evaluation. physical examinaton revealed HB 12G/dL ,HR:103/mt,BP 130/90 mm of Hg, and temperature 98.6 F. She gives the histrory of diabetes for which she is taking oral hypoglycemic drugs and it is in good controll. what is the most appropriate method of investigation to find out malformations in foetus?
a.ultrasound
b.MS-AFP
C.FOETAL ECHO
D.chorinoic villous bipsy
e.PUBS
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| titly
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USG
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we spend our days waiting for the ideal path to appear in front of us, but, what we forget is paths are made by walking, not by waiting. keep walking................................
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| hanialkhadher
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"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| Kamsi
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A Ultrasound
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| kpmle2
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a.ultrasound
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| MAGY17
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l go for MS AFP, BECAUSE the u/s for malformation will be at 20 weeks, now the gestation age is 17, is time to do ms afp anyway or not?
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| kpmle2
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U/S ,b/n 18 to 20 weeks optimal to find anatomical structural defects
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| MAGY17
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the qs asked about malformation, is not in general?
because if the qs asked about anatomical structural defect then l will agree with U/S, please more repley about
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| kpmle2
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oral hypoglycemic drugs are CI b'cos of fetal hypoglycemia.
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| MAGY17
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MS AFP= maternal serum alpha feto protein
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| MAGY17
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yes oral hipoglycemic drug are contraindiceted in pregnant the mother will be change to insulin
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| SDdawg
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Answer: Fetal Echocardiogram (ECHO)
Rationale:
Gestational DM (NOT our patient in the vignette): NOT associated with fetal malformations since this insulin resistance tends to develop in the 3rd trimester, well outside the comfort zone of fetal ORGANOGENESIS!!
However, Pre- GDM, on the other hand, is a significant risk factor for major congenital malformations since this insulin resistance and other factors will be present during Organogenesis, affecting the dvpt of the heart. Hence, a Fetal Echo is recommended to detect congenital heart defects. It is not recommended in GDM. Also, a HbgA1C will be a very good predictor of the risk of having a malformation, e.g., a HBG A1C of 12% has almost a 25% risk of having an associated malformation.
Of note is that there have been many studies showing that Glyburide (glibenclamide), an oral hypoglycemic of the sulfonylurea class I believe does not cross the placenta but further studies need to be done.
I apologize for this drawn out explanation but I could not resist myself.
Bonus:
ANTENATAL TESTING to evaluate fetal-well being should be initiated in the following cases:
1. GDM, Class A2 diabetics on Insulin @ 32-34 weeks GA
2. Pre-GDM + Fetal ECHO
3. IUGR b/c this is an indication for immediate delivery, if mature.
Now I can go back to brooding b/c my ND Fighting Irish lost today. 
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| MAGY17
Forum Elite
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sddawg, thanks for the posted you`re right, the ans is U/S.
l happy , because l was confused now an bery clear about this topic.
(read diferent books and finally l get)
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| njcjzy
Forum Guru
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But fetal echo and ultrasound are different answers listed?
Any more explanations?
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| hanialkhadher
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SDdawg wrote:Answer: Fetal Echocardiogram (ECHO) Rationale: Gestational DM (NOT our patient in the vignette): NOT associated with fetal malformations since this insulin resistance tends to develop in the 3rd trimester, well outside the comfort zone of fetal ORGANOGENESIS!! However, Pre- GDM, on the other hand, is a significant risk factor for major congenital malformations since this insulin resistance and other factors will be present during Organogenesis, affecting the dvpt of the heart. Hence, a Fetal Echo is recommended to detect congenital heart defects. It is not recommended in GDM. Also, a HbgA1C will be a very good predictor of the risk of having a malformation, e.g., a HBG A1C of 12% has almost a 25% risk of having an associated malformation. Of note is that there have been many studies showing that Glyburide (glibenclamide), an oral hypoglycemic of the sulfonylurea class I believe does not cross the placenta but further studies need to be done. I apologize for this drawn out explanation but I could not resist myself. Bonus: ANTENATAL TESTING to evaluate fetal-well being should be initiated in the following cases: 1. GDM, Class A2 diabetics on Insulin @ 32-34 weeks GA 2. Pre-GDM + Fetal ECHO 3. IUGR b/c this is an indication for immediate delivery, if mature. Now I can go back to brooding b/c my ND Fighting Irish lost today.
Thank youThis is really nice explanation, But it would be correct if done after 20-22 weeks which is the time for fetal echo,While this patient is in the time for MS-AFP or U/S .,and Diabetes is a risk factor for neural tube deffects.
So we have only MS-AFP and U/S
I will pick MS-AFP 
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"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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| hanialkhadher
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hanialkhadher wrote: Thank you,This is really nice explanation, But it would be correct if done after 20-22 weeks which is the time for fetal echo,While this patient is in the time for MS-AFP or U/S .,and Diabetes is a risk factor for neural tube deffects. So we have only MS-AFP and U/S I will pick MS-AFP
___________________
"أقرأ بأسم ربك الذي خلق,خلق الأنسان من علق,أقرأ و ربك الأكرم, الذي علم بالقلم,علم الأنسان ما لم يعلم"
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