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Re: OB: Management PleaseFrom: Peter Wein (p.wein@obsgyn-mercy.unimelb.EDU.AU)Tue Apr 28 21:49:49 1998
At 12:06 PM 28/04/98 -0500, you wrote: >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. Placenta is anterior. Interestingly, her platelet >count, which was 178K on first visit, is now 100K. PIH has been ruled >out. 24 hr urine this week was 100mg and all other biochemical data is >within normal limits. BPs are all normal. Her cervix is FT dialted >thick and high. She is cephalic. > >Management suggestions? > >A) Tap and induce if mature L/S and PG. >B) Induce regardless. >C) Continue with antenatal testing and allow her to go into spontaneous >labor. >D) Other > >Geffrey H Klein, MD >Dept OB-GYN >MacGregor Medical Association >2200 Nasa Road 1 Suite 200 >Houston, Texas 77058 >(713) 741-2273 ext. 2628 >geffrey.klein@obgyn.net > D - no indication for delivery now - not too big, GDM is controlled, on my charts this is not macrocosmic. The thrombocytopaenia is "gestational thrombocytopaenia" - a benign condition that needs no further investigation nor treatment. I would induce labour at 40 weeks or thereabouts.
-- Peter Wein Senior Lecturer Department of Obstetrics and Gynaecology University of Melbourne, Mercy Hospital for Women Clarendon Street, East Melbourne 3002 Australia Tel: +61 3 9270 2556 Fax: +61 3 9417 5406 Mobile: 0414 691690
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