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Re: OB: Management PleaseFrom: Malcolm Griffiths (Malcolm@MGRIFF22.demon.co.uk)Tue Apr 28 15:43:12 1998
In message <c=US%a=_%p=Americal_Medical%l=AMM1EXCH-980428170515Z- 1951@amm2mg1.americanmed.com>, Geffrey Klein <GK6972@americanmed.com> writes >Requesting opinions: > >22 y/o G1 today is 38 2/7 wks by 9 wk CRL. Pt is gestational diabetic >class A2 on 8 U of insulin a day with good control (hgba1c = 6) . She >was placed on insulin by perinatology due to some elevated postprandial >glucose measurements on diet only. Fetal monitor has been reactive each >week. US was done on 4/24 for S>D was 3569g and 90% for EGA of 37.8 >wks. AFI was 13.2. D) Other > Sorry for entering this discussion late in the day. There is no evidence that diagnosing and "treating" GDM alters any perinatal outcome USEFULLY (ie it bumps up the CS rate but don't help the baby). Thererfore this woman should be managed as if she had an entirely normal pregnancy. She should never have been encumbered by a homeopathic dose of insulin or dietary restriction. She should be left until 41 weeks complted gestation and then be induced on basis of post- datism in a normal pregnancy - unless already delivered!!! Malcolm Griffiths MD,MRCOG,MFFP,Cert.Mgmnt Obstetrician & Gynaecologist Luton & Dunstable Hosp.,UK. Tel: 01582-497459 (office) Fax: 01582-497376 01525-222849 (home) email: Malcolm@mgriff22.demon.co.uk http://www.obgyn.net/board/griffith.htm "CLINICAL FREEDOM IS THE LAST REFUGE OF THE CLINICALLY INCOMPETENT!" (Someone [1997])
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