Deviation in the Standard of Obstetrical Care When Treating a Diabetic Mother (Gestational Diabetes)

Evaluate breaches in the standard of care to determine whether or not there has been a Deviation in the Standard of Obstetrical Care When Treating a Diabetic Mother (Gestational Diabetes)

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Fatigue
    Abdominal discomfort
    Weight loss
    Polyuria/Polydipsia/Polyphagia
    None of the above
    Not elicited
    Answer unknown
    Why is this important?
    There are no specific symptoms of gestational diabetes mellitus.
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  • Was pre-conception care provided to the diabetic patient? Why is this important?
    Answer this question
    
Pre-conception care aims to improve the outcome of pregnancy. The two most important concerns are imparting relevant information to improve knowledge and supporting women to modify their behavior based on the knowledge gained.

    (2005) 10 ESNEON 4 325-332 



  • Was a medical history performed? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests.

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  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    
A risk factor is a variable that has a causal association with a disease or disease process; the presence of the variable in an individual or a population is associated with an increased risk of the presence or future development of the disease. Thus, risk factors may be useful for identifying subjects at increased risk for a disease or for a particular outcome that results from a disease process.

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  • Was a physical examination performed? Why is this important?
    Answer this question
    
A complete medical history and carefully focused physical examination serve as the core of the diagnostic process. The information obtained guides the further direction of the patient's evaluation and enables the clinician to make the most judicious use of additional tests. 

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  • Which of the following screening modalities were performed? (Choose all that apply) Why is this important?
    Answer this question
    
Gestational diabetes mellitus is defined as glucose intolerance that begins, or is first recognized, during pregnancy. Initial screening for gestational diabetes is accomplished by performing a 50-g, one-hour glucose challenge test at 24 to 28 weeks of gestation

    (2012) 39 EPCCOP 1 83-94 



  • Was a follow up test performed for questionable serum glucose levels? Why is this important?
    Answer this question
    
If the 1-hour screening test is abnormal, a 3-hour fasting, 100-g glucose tolerance test needs to be performed to diagnose gestational diabetes mellitus.

    (2012) 39 EPCCOP 1 83-94 



  • To which of the following specialists was the patient referred? (Choose all that apply) Why is this important?
    Answer this question
    
Women with established diabetes should be referred to an ophthalmologist for regular retinal examination, beginning in the first trimester. Pregnant patients diagnosed with overt diabetes mellitus require referral to diabetologist.

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  • Which of the following treatment options were initiated? (Choose all that apply) Why is this important?
    Answer this question
    
Self monitoring of blood glucose and diet are the cornerstones for achieving the set targets of plasma glucose in order to reduce perinatal mortality. 
Review; Gestational diabetes mellitus;
    (2008) 2 EDMSCS 3 227-234 



  • Were glucose levels monitored throughout the pregnancy? Why is this important?
    Answer this question
    
Insulin requirements change throughout pregnancy. The glucose targets during pregnancy are more stringent so that the primary complication of diabetic pregnancies is avoided. Maintaining normoglycemia throughout pregnancy is the therapeutic goal.
Management of Diabetes in Pregnancy, Childhood, and Adolescence;
    (2007) 34 EPCCOP 4 809-843 



  • Which of the following were not performed? (Choose all that apply) Why is this important?
    Answer this question
    
Fetal monitoring can be a marker for adequate maternal glycemic control. Fetal monitoring can also detect congenital malformation through sonography in women with fasting plasma glucose greater than 120 mg/dl. 

    (2008) 2 EDMSCS 3 227-234 



  • Was an ultrasound performed? Why is this important?
    Answer this question
    
Pre-existing diabetes increases the risk of many congenital malformations and has a predisposition for large for gestational age babies. 

    (2012) 39 EPCCOP 1 83-94 



  • Was fetal echocardiography performed? Why is this important?
    Answer this question
    
It is recommended that all diabetic women undergo fetal echocardiography during 18 to 24 weeks to assess for congenital heart defects of the baby. 

    (2001) 28 ECLPER 1 31-70 



  • Were ketone levels monitored? Why is this important?
    Answer this question
    
The three primary goals in antenatal management of gestational diabetes mellitus are to prevent macrosomia, avoid ketosis and detect pregnancy complications. 

    (2012) 39 EPCCOP 1 83-94 



  • Were periodic ultrasounds performed? Why is this important?
    Answer this question
    
Ultrasonography is commonly performed early in the second trimester and repeated to evaluate excessive or inadequate growth of the baby. Ultrasonography may be performed more frequently for patients treated with insulin or oral hypoglycemic agents.

    (2012) 39 EPCCOP 1 83-94 



  • Which of the following antenatal tests were performed in high-risk patients? (Choose all that apply) Why is this important?
    Answer this question
    
Ultrasonography is commonly performed early in the second trimester and repeated to evaluate excessive or inadequate growth of the baby. Ultrasonography may be performed more frequently for patients treated with insulin or oral hypoglycemic agents.

    (1998) 178 ESAJOG 6 1321-1332 



  • Was the fetal weight measured and monitored? Why is this important?
    Answer this question
    
The macrosomia or elevated birth weight may cause complications such as shoulder dystocia, clavicle fractures and brachial plexus injury during delivery. 

    (2002) 102 JNLADA 2 241-243 



  • Was a cesarean section advised? Why is this important?
    Answer this question
    
Cesarean delivery is indicated in cases of fetal macrosomia.

    (2012) 39 EPCCOP 1 83-94 



  • Were glucose levels maintained during labor and delivery? Why is this important?
    Answer this question
    
Tight glycemic control during delivery is necessary to reduce the excess fetal oxygen need that high glucose supplies demand. 

    (2011) 40 ENMCNA 4 727-738