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Gestational Diabetes Insulin Management Intrapartum

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61. Liver Disease and Pregnancy (Overview)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) insulin sensitivity and increased baseline cortisol levels in the children of mothers with severe hyperemesis compared to those in the control group. [ ] The lifelong effect of this difference in still unknown, but it may place these children at higher risk for type 2 diabetes and cardiovascular disease. Previous Next: Acute Fatty Liver of Pregnancy The prevalence of , in which microvesicular fatty infiltration of the liver can lead to liver failure, [ ] is 1 per 10,000-15,000 pregnancies. This life

2014 eMedicine.com

62. Macrosomia (Treatment)

program. Intuitively, this type of intervention, if successful, may reduce the risks of macrosomia in those women who are obese prior to pregnancy or who may gain excessive weight in pregnancy. In diabetic patients, maternal diet alone, without the use of insulin, did not alter rates of macrosomia. [ , ] Excessive maternal weight gain can double the risk of macrosomia; thus, a reasonable suggestion is careful weight control for women who exceed the recommended weight gain in pregnancy. [ , , ] A multi (...) -center RCT by Landon et al assessed 958 women with mild gestational diabetes and randomized them to usual prenatal care vs diet and lifestyle intervention with treatment as medically indicated for glycemic control. The study found a statistically significant difference in the control group vs treatment group in the frequency of large-for-gestational-age infants, 14.5% vs 7.1%, as well as reduced frequency of shoulder dystocia (4.0% vs 1.5%) and birth weight over 4000 g (14.3% v 5.9%). [ ] Dietary

2014 eMedicine.com

63. Fetal Growth Restriction (Treatment)

rates in association with determinants of small for gestational age fetuses: population based cohort study. BMJ . 1998 May 16. 316(7143):1483-7. . Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol . 1999 Apr. 106(4):309-17. . Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia . 1992 Jul. 35(7):595-601. . Hepburn M, Rosenberg K. An audit (...) the following: Placental abnormalities Chronic abruption Abnormal cord insertion Cord anomalies Multiple gestations IUGR occurs when gas exchange and nutrient delivery to the fetus are not sufficient to allow it to thrive in utero. This process can occur primarily because of maternal disease causing decreased oxygen-carrying capacity (eg, cyanotic heart disease, smoking, hemoglobinopathy), a dysfunctional oxygen delivery system secondary to maternal vascular disease (eg, diabetes with vascular disease

2014 eMedicine.com

64. Estimation of Fetal Weight (Treatment)

birth weight Endogenous and extrinsic factors such as the following can affect fetal birth weight: Gestational age at delivery, fetal sex Maternal race, height, weight, parity, pregnancy weight gain and physical activity, hemoglobin concentration, tobacco use, uncontrolled diabetes, hypertension, preeclampsia Paternal height Ambient altitude Techniques to estimate fetal weight The accuracy of different methods for predicting fetal weight depends on the gestational age and the range of birth weights (...) ), [ , , , , , , , , , , , , ] paternal factors (eg, paternal height), [ , , , , , , , , ] environmental influences (eg, altitude, availability of adequate nutrition, degree of physical activity), [ , , , , , , , , , ] physiologic factors (eg, altered glucose metabolism, hemoglobin concentration, microvascular integrity), [ , , , , ] pathologic factors (eg, hypertension, uterine malformations), [ , , ] and complications of pregnancy (eg, gestational diabetes mellitus, preeclampsia). [ , , , , , , ] In a systematic review of 36

2014 eMedicine.com

65. Liver Disease and Pregnancy (Treatment)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) insulin sensitivity and increased baseline cortisol levels in the children of mothers with severe hyperemesis compared to those in the control group. [ ] The lifelong effect of this difference in still unknown, but it may place these children at higher risk for type 2 diabetes and cardiovascular disease. Previous Next: Acute Fatty Liver of Pregnancy The prevalence of , in which microvesicular fatty infiltration of the liver can lead to liver failure, [ ] is 1 per 10,000-15,000 pregnancies. This life

2014 eMedicine.com

66. Normal and Abnormal Puerperium (Follow-up)

. These individuals should be appropriately counselled on lifestyle interventions or medical management options (i.e. metformin, insulin) to optimize their glycemic control. Those who have a normal postpartum glucose tolerance test should be appropriately counselled that there is still a 7 fold risk of developing type 2 diabetes later in life and up to 50% of women with GDM will develop diabetes over 20 years after her pregnancy. [ ] Therefore the American Diabetes Association (ADA) recommends patients with GDM (...) scheduled for a routine comprehensive postpartum evaluation between 4 to 6 weeks after delivery. Earlier postpartum follow-up is recommended in women at high risk of postpartum complications who require problem-oriented visits for closer management of hypertensive issues, postpartum depression, wound infections, lactation difficulties, or comorbidities that require postpartum medication changes (i.e. seizure disorder, diabetes). [ ] The postpartum visit is also an important time to identify

2014 eMedicine.com

67. Liver Disease and Pregnancy (Follow-up)

, nephrolithiasis, ovarian torsion, hyperthyroidism, diabetic ketoacidosis, and migraines. Risk factors Risk factors for hyperemesis gravidarum include past history of the disease, hyperthyroidism, psychiatric illness, molar pregnancy, preexisting diabetes, multiple gestations, multiparity, increased body mass index, and high daily intake of saturated fat before pregnancy. One study also identified female sex of the fetus as a risk factor. [ ] An association between Helicobacter pylori infection and hyperemesis (...) insulin sensitivity and increased baseline cortisol levels in the children of mothers with severe hyperemesis compared to those in the control group. [ ] The lifelong effect of this difference in still unknown, but it may place these children at higher risk for type 2 diabetes and cardiovascular disease. Previous Next: Acute Fatty Liver of Pregnancy The prevalence of , in which microvesicular fatty infiltration of the liver can lead to liver failure, [ ] is 1 per 10,000-15,000 pregnancies. This life

2014 eMedicine.com

68. Macrosomia (Follow-up)

mothers and in those with gestational diabetes, tight control during pregnancy with the use of diet and insulin can reduce the frequency of macrosomia. The association between post-meal glucose levels and fetal macrosomia has been studied and illustrated. [ ] Prevention of maternal obesity before pregnancy may reduce the frequency of macrosomia. However, no clinical randomized trials have validated this hypothesis. Obesity is also associated with other morbidities in pregnancy, including higher rates (...) and deserves careful long-term follow-up care. This risk of developing a metabolic syndrome in adolescents was recently addressed by Boney et al in a study of appropriate for gestational age (AGA) and large for gestational age (LGA) infants of women with normal glucose tolerance and gestational diabetes mellitus (GDM). [ ] Metabolic syndrome was defined as two or more of the following being present: obesity, hypertension, glucose intolerance, and dyslipidemia. Children who were LGA at birth had

2014 eMedicine.com

69. Estimation of Fetal Weight (Follow-up)

birth weight Endogenous and extrinsic factors such as the following can affect fetal birth weight: Gestational age at delivery, fetal sex Maternal race, height, weight, parity, pregnancy weight gain and physical activity, hemoglobin concentration, tobacco use, uncontrolled diabetes, hypertension, preeclampsia Paternal height Ambient altitude Techniques to estimate fetal weight The accuracy of different methods for predicting fetal weight depends on the gestational age and the range of birth weights (...) ), [ , , , , , , , , , , , , ] paternal factors (eg, paternal height), [ , , , , , , , , ] environmental influences (eg, altitude, availability of adequate nutrition, degree of physical activity), [ , , , , , , , , , ] physiologic factors (eg, altered glucose metabolism, hemoglobin concentration, microvascular integrity), [ , , , , ] pathologic factors (eg, hypertension, uterine malformations), [ , , ] and complications of pregnancy (eg, gestational diabetes mellitus, preeclampsia). [ , , , , , , ] In a systematic review of 36

2014 eMedicine.com

70. Fetal Growth Restriction (Follow-up)

rates in association with determinants of small for gestational age fetuses: population based cohort study. BMJ . 1998 May 16. 316(7143):1483-7. . Gardosi J, Francis A. Controlled trial of fundal height measurement plotted on customised antenatal growth charts. Br J Obstet Gynaecol . 1999 Apr. 106(4):309-17. . Hales CN, Barker DJ. Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesis. Diabetologia . 1992 Jul. 35(7):595-601. . Hepburn M, Rosenberg K. An audit (...) the following: Placental abnormalities Chronic abruption Abnormal cord insertion Cord anomalies Multiple gestations IUGR occurs when gas exchange and nutrient delivery to the fetus are not sufficient to allow it to thrive in utero. This process can occur primarily because of maternal disease causing decreased oxygen-carrying capacity (eg, cyanotic heart disease, smoking, hemoglobinopathy), a dysfunctional oxygen delivery system secondary to maternal vascular disease (eg, diabetes with vascular disease

2014 eMedicine.com

71. Neonatology Considerations for the Pediatric Surgeon (Diagnosis)

the risk of non-insulin-dependent diabetes mellitus (NIDDM), coronary heart disease, hypertension, and stroke. This has led to a rapidly growing field: study of the fetal origins of adult diseases. Large for gestational age (LGA) infants are those whose weight is greater than 90th percentile for their gestational age. These infants are at increased risk for perinatal asphyxia, birth injury, hypoglycemia, , polycythemia, and thrombocytopenia. Infants of mothers with diabetes are often large (...) Neonatology Considerations for the Pediatric Surgeon (Diagnosis) Neonatology Considerations for the Pediatric Surgeon: Neonatal Gestational Age and Birth Weight, Neonatal Fluid and Electrolyte Management, Neonatal Ventilatory Management Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method

2014 eMedicine Pediatrics

72. Neonatology Considerations for the Pediatric Surgeon (Treatment)

the risk of non-insulin-dependent diabetes mellitus (NIDDM), coronary heart disease, hypertension, and stroke. This has led to a rapidly growing field: study of the fetal origins of adult diseases. Large for gestational age (LGA) infants are those whose weight is greater than 90th percentile for their gestational age. These infants are at increased risk for perinatal asphyxia, birth injury, hypoglycemia, , polycythemia, and thrombocytopenia. Infants of mothers with diabetes are often large (...) Neonatology Considerations for the Pediatric Surgeon (Treatment) Neonatology Considerations for the Pediatric Surgeon: Neonatal Gestational Age and Birth Weight, Neonatal Fluid and Electrolyte Management, Neonatal Ventilatory Management Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method

2014 eMedicine Pediatrics

73. Neonatology Considerations for the Pediatric Surgeon (Overview)

the risk of non-insulin-dependent diabetes mellitus (NIDDM), coronary heart disease, hypertension, and stroke. This has led to a rapidly growing field: study of the fetal origins of adult diseases. Large for gestational age (LGA) infants are those whose weight is greater than 90th percentile for their gestational age. These infants are at increased risk for perinatal asphyxia, birth injury, hypoglycemia, , polycythemia, and thrombocytopenia. Infants of mothers with diabetes are often large (...) Neonatology Considerations for the Pediatric Surgeon (Overview) Neonatology Considerations for the Pediatric Surgeon: Neonatal Gestational Age and Birth Weight, Neonatal Fluid and Electrolyte Management, Neonatal Ventilatory Management Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method

2014 eMedicine Pediatrics

74. Pediatrics, Hypoglycemia (Diagnosis)

population growth standards and does it matter?. J Matern Fetal Neonatal Med . 2010 Jan. 23(1):48-54. . Vanhaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being 'infant of a diabetic mother'. J Pediatr Endocrinol Metab . 2013 May 17. 1-5. . Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern Health Neonatol Perinatol . 2016. 2:3. . . Joshi T, Oldmeadow C, Attia J, Wynne K. The duration of intrapartum maternal hyperglycaemia predicts (...) , endotoxin shock, and ingestions, including of salicylates, alcohol, hypoglycemic agents, or beta-adrenergic blocking agents. Excluding insulin therapy, almost all hypoglycemia in childhood occurs during fasting. Postprandial hypoglycemia is rare in children in the absence of prior gastrointestinal (GI) surgery. Management efforts are directed toward the immediate normalization of glucose levels and the identification and treatment of the various causes. (See Treatment and Medications.) Patient education

2014 eMedicine Emergency Medicine

75. Normal and Abnormal Puerperium (Diagnosis)

. These individuals should be appropriately counselled on lifestyle interventions or medical management options (i.e. metformin, insulin) to optimize their glycemic control. Those who have a normal postpartum glucose tolerance test should be appropriately counselled that there is still a 7 fold risk of developing type 2 diabetes later in life and up to 50% of women with GDM will develop diabetes over 20 years after her pregnancy. [ ] Therefore the American Diabetes Association (ADA) recommends patients with GDM (...) scheduled for a routine comprehensive postpartum evaluation between 4 to 6 weeks after delivery. Earlier postpartum follow-up is recommended in women at high risk of postpartum complications who require problem-oriented visits for closer management of hypertensive issues, postpartum depression, wound infections, lactation difficulties, or comorbidities that require postpartum medication changes (i.e. seizure disorder, diabetes). [ ] The postpartum visit is also an important time to identify

2014 eMedicine.com

76. Pediatrics, Hypoglycemia (Treatment)

Neonatal Med . 2016 Jul 17. 1-16. . Yamamoto JM, Kallas-Koeman MM, Butalia S, Lodha AK, Donovan LE. Large-for-Gestational-Age Neonate Predicts a 2.5-Fold Increased Odds of Neonatal Hypoglycemia in Women with Type 1 Diabetes. Diabetes Metab Res Rev . 2016 May 17. . Raghuveer TS, Garg U, Graf WD. Inborn errors of metabolism in infancy and early childhood: an update. Am Fam Physician . 2006 Jun 1. 73(11):1981-90. . Ishiguro A, Namai Y, Ito YM. Managing "healthy" late preterm infants. Pediatr Int . 2009 (...) Nov. 161(5):787-91. . Narchi H, Skinner A, Williams B. Small for gestational age neonates--are we missing some by only using standard population growth standards and does it matter?. J Matern Fetal Neonatal Med . 2010 Jan. 23(1):48-54. . Vanhaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being 'infant of a diabetic mother'. J Pediatr Endocrinol Metab . 2013 May 17. 1-5. . Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern

2014 eMedicine Emergency Medicine

77. Neonatology Considerations for the Pediatric Surgeon (Follow-up)

the risk of non-insulin-dependent diabetes mellitus (NIDDM), coronary heart disease, hypertension, and stroke. This has led to a rapidly growing field: study of the fetal origins of adult diseases. Large for gestational age (LGA) infants are those whose weight is greater than 90th percentile for their gestational age. These infants are at increased risk for perinatal asphyxia, birth injury, hypoglycemia, , polycythemia, and thrombocytopenia. Infants of mothers with diabetes are often large (...) Neonatology Considerations for the Pediatric Surgeon (Follow-up) Neonatology Considerations for the Pediatric Surgeon: Neonatal Gestational Age and Birth Weight, Neonatal Fluid and Electrolyte Management, Neonatal Ventilatory Management Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method

2014 eMedicine Pediatrics

78. Pediatrics, Hypoglycemia (Overview)

population growth standards and does it matter?. J Matern Fetal Neonatal Med . 2010 Jan. 23(1):48-54. . Vanhaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being 'infant of a diabetic mother'. J Pediatr Endocrinol Metab . 2013 May 17. 1-5. . Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern Health Neonatol Perinatol . 2016. 2:3. . . Joshi T, Oldmeadow C, Attia J, Wynne K. The duration of intrapartum maternal hyperglycaemia predicts (...) , endotoxin shock, and ingestions, including of salicylates, alcohol, hypoglycemic agents, or beta-adrenergic blocking agents. Excluding insulin therapy, almost all hypoglycemia in childhood occurs during fasting. Postprandial hypoglycemia is rare in children in the absence of prior gastrointestinal (GI) surgery. Management efforts are directed toward the immediate normalization of glucose levels and the identification and treatment of the various causes. (See Treatment and Medications.) Patient education

2014 eMedicine Emergency Medicine

79. Pediatrics, Hypoglycemia (Follow-up)

Neonatal Med . 2016 Jul 17. 1-16. . Yamamoto JM, Kallas-Koeman MM, Butalia S, Lodha AK, Donovan LE. Large-for-Gestational-Age Neonate Predicts a 2.5-Fold Increased Odds of Neonatal Hypoglycemia in Women with Type 1 Diabetes. Diabetes Metab Res Rev . 2016 May 17. . Raghuveer TS, Garg U, Graf WD. Inborn errors of metabolism in infancy and early childhood: an update. Am Fam Physician . 2006 Jun 1. 73(11):1981-90. . Ishiguro A, Namai Y, Ito YM. Managing "healthy" late preterm infants. Pediatr Int . 2009 (...) Nov. 161(5):787-91. . Narchi H, Skinner A, Williams B. Small for gestational age neonates--are we missing some by only using standard population growth standards and does it matter?. J Matern Fetal Neonatal Med . 2010 Jan. 23(1):48-54. . Vanhaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being 'infant of a diabetic mother'. J Pediatr Endocrinol Metab . 2013 May 17. 1-5. . Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern

2014 eMedicine Emergency Medicine

80. Haemodynamic Effects of Oxytocin and Carbetocin

caesarean section with regional anesthesia Exclusion Criteria: ---Women with placenta praevia placental abruption multiple gestation pregnancy related complications and disorders (i.e. preeclampsia, gestational diabetes) pre-existing diseases (e.g. insulin-dependent diabetes, cardiovascular or renal diseases, thyroid disease taking medication with known impact on the cardiovascular system undergoing caesarean section with general anesthesia secondary caesarean section Contacts and Locations Go (...) Haemodynamic Effects of Oxytocin and Carbetocin Haemodynamic Effects of Oxytocin and Carbetocin - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Haemodynamic Effects of Oxytocin and Carbetocin The safety

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