Friday, 7 February 2014

Tutorial 3rd. February 2014

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Tonight we had a tutorial by Claire Candelier on diabetes.
She discussed what should go into three essays on the subject.
The essays are below and on Dropbox.
Write plans before you listen to the podcast.



A 28-year old woman receiving midwifery-led care is referred to antenatal clinic at 28 weeks of gestation following a 75g oral glucose tolerance test performed because of her father suffering from type 2 diabetes. The results of the venous plasma glucose samples are a fasting of 5.0 mmol/l and a 2-hour of 8.7 mmol/l. Your unit uses the IADPSG recommended threshold values with diabetes diagnosed where one or more threshold value is exceeded (fasting ≥5.1mmol/l, 1-hour ≥10.0 mmol/l and 2-hour ≥8.5 mmol/l. She is a Para 1+0 having had a spontaneous vaginal delivery at term +10 days of a female infant with a birth weight of 3.98kg. Her BMI at booking was 29.5.


A.    Discuss the rationale for treatment and the effect of treating this abnormal glucose tolerance test result on her pregnancy, labour and delivery. (7 marks)


  1. Discuss your immediate management options. (6 marks)

 
  1. What specific dietary advice you would give her, explaining the aims of dietary advice?
(7 marks)

    



A 30-year old woman is seen at the antenatal clinic after her 20-week fetal anomaly scan in her second pregnancy. In her first pregnancy, she had a ventouse delivery at 42 weeks of a male infant weighting 4.8kg. Her BMI at booking is 35. She is worried about the risks of having another “big baby”.

A. Discuss her risk factors for fetal macrosomia. (4 marks)


B. What advice could you offer her to reduce the risks of having another “big baby”? (4 marks)


C. At 28 weeks of gestation, she is diagnosed with gestational diabetes following a 75gm oral glucose tolerance test. Discuss your antenatal management. What advice you would give her regarding timing and mode of delivery?  (8 marks)


D. She has a vaginal delivery of a male infant weighing 4kg at 39 weeks. What advice would you give her prior to her discharge home from hospital? (4 marks)





A 28-year old woman attends the pregnancy counselling clinic. She is a Para 0+1, having suffered a miscarriage at 10 weeks of gestation six months ago. She is wishing to conceive. She is currently using condoms for contraception. Aged 12, she was diagnosed with type1 diabetes and takes humalog mix 50. Her BMI is 22. There is a strong family history of hypertensive disorders. 

A. What investigations would you perform and explain the rationale for doing these? (6 marks)


B. What other advice would you give her? (6 marks)


C. Five months later, the woman is seen in the antenatal clinic after a dating scan at 12 weeks of gestation. This is her first hospital visit in this pregnancy. Discuss your antenatal care plan. (8 marks)






 





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