Malpresentations and Positions & Operative Obstetrics
Your patient is a 40-yrs-old G3P2 obese woman at 37 weeks gestation. Her pregnancy has been complicated by insulin-requiring gestational diabetes. Her most recent HbA1c was 6.0. The patient reports that her fasting and postprandial sugars have all been within normal range. Her fetus has an estimated weight of 3kg Leopold’s today. All of the following are correct ways to manage this patient except:
|A||The patient should undergo an elective cesarean section at 38 weeks to avoid shoulder dystocia|
|B||The patient should be induced by 39-40 weeks if spontaneous labor does not occur|
|C||After 6 weeks postpartum, the patient should undergo a 75-g glucose tolerance test|
|D||In the postpartum period, it is acceptable to use oral contraceptives.|
The patient should undergo an elective cesarean section at 38 weeks to avoid shoulder dystocia
a. In the well-controlled diabetic patient who does not have any other complications, induction by 39-40 weeks is usually undertaken.
b. In general, women are offered elective cesarean delivery if the estimated fetal weight is greater than 4500 g to avoid the possible risk of shoulder dystocia with resultant brachial plexus injury to the neonate. Laboring women with gestational diabetes can be managed in labor with a constant infusion of 5% dextrose and an insulin drip as needed.
c. Women with gestational diabetes are at an increased risk of developing diabetes later in life. Therefore, women with GDM should undergo a 75 glucose tolerance test 2 to 4 months postpartum. Women experiencing gestational diabetes may safely use combination oral contraceptive pills in the postpartum period.