OB-GYN-L Messages for January, 2008: Re: Care of pregnancy in a patient who has had a Whipples procedure.

Re: Care of pregnancy in a patient who has had a Whipples procedure.

From: Andrew Folley

agfolley@hotmail.com

Mon Jan 14 10:34:21 2008

2. Recall her 1 hour GTT was abnormal at 19 weeks. HbA1C to give measure of diabetic control over the past 12 weeks.

Date: Mon, 14 Jan 2008 09:37:08 -0600From: Stephen.Raymond@dhhs.tas.gov.auTo: ob-gyn-l@dns.obgyn.netSubject: RE: Care of pregnancy in a patient who has had a Whipples procedure.

If you control her postprandial blood sugars at 1 hour to less than 7.8 there will be very little chance that any complication will occur relating to her diabetes. If the baby should weigh >4500gm at 37 -38 weeks then you haven't done your job. Where is the evidence that a properly controlled diabetic needs delivery at 39 weeks? Tell me how the HbA1C helps in the management?

Steve

From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Andrew FolleySent: Monday, 14 January 2008 3:11 PMTo: Multiple recipients of list OB-GYN-LSubject: RE: Care of pregnancy in a patient who has had a Whipples procedure. 1. Do not need to do biophysical profiles weeksy. NST biweekly and afi with the NST is sufficient (equivocal to biophysical profile)2. Deliver at 39 weeks if euglycemic 3. Vaginal birth unless obstetrical complications or4. CS if weight >4500 grams at 37-38 weeks?4. Watch serial growth with US for growth q 3 weeks5. HbA1C> Date: Sun, 13 Jan 2008 05:46:12 -0600> From: johnprov@sympatico.ca> To: ob-gyn-l@dns.obgyn.net> Subject: Care of pregnancy in a patient who has had a Whipples procedure.> > 31 y.o. G1 who had a Whipple’s procedure at age of 26 for what turned> out to be a benign neuroendocrine tumor. She has done remarkably well> after her surgery and has essentially lead a normal life with no special> modifications in diet, life style or need of meds. I sent her off for> her glucose tolerance rest after her second visit at 19 weeks and the 1> hr value was 14.7(14.7 X18 &4.6) (for those who still live with the> old units), with that value I sent her off to our local Endocrinologists> for start of insulin and any other recommendations. Now at 26 wks and> started fetal surveillance with biweekly NST weekly biophysical> profiles, dopplers of umbilical vessels normal and normal Middle> cerebral flow. Besides taking all the precautions for gestational> diabetic requiring insulin, does anyone have any other suggestions?> > --> Take care, John

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