(BQ) Case files – High risk obstetrics uses fifty clinical cases to illustrate evidence-based practice in high-risk obstetrics patients. Each case includes open-ended questions, extended discussion, Practice Pearls, a “Controversy” discussion, comprehension questions, and references to the most current literature with a brief critique of each article. | Case 19 A 30-year-old G2P0020 presents to the office for preconception counseling secondary to an 8-year history of diabetes mellitus. She regularly sees an internist who manages her diabetes and general medical care. She has been treated with multiple oral hypoglycemic medications in order to achieve appropriate glycemic control. Her current regimen includes glyburide which she has taken for the past year and metformin which was added 6 months prior to improve her level of glycemic control. She denies hypertension, retinopathy, and renal disease. Her obstetric history is significant for two first trimester pregnancy losses occurring 1 and 3 years prior. The patient and her husband are contemplating a pregnancy; however she is concerned about her risk of pregnancy loss and other potential effects of diabetes on her pregnancy. ➤ What is the next step in evaluating this patient? ➤ What are potential maternal complications of diabetes mellitus in pregnancy? ➤ What are potential fetal complications? ➤ How would you counsel this patient in terms of pregnancy planning? ➤ How would you manage her if she became pregnant? 212 CASE FILES: High-Risk Obstetrics ANSWERS TO CASE 19: Pregestational Diabetes Summary: An essential nulliparous with a personal history of diabetes and multiple pregnancy losses presents for preconception counseling. ➤ First step in evaluating this patient: A detailed history and physical examination including baseline laboratory testing should be completed to assess the severity of her disease. A conversation should be had stressing the importance of effective contraception to ensure that conception does not occur until diabetic control is optimized. ➤ Potential maternal complications of diabetes mellitus in pregnancy: Women with diabetes who become pregnant often experience less stable glycemic control. They are also at increased risk of chronic hypertension, preeclampsia, diabetic retinopathy, and cesarean delivery. ➤ Potential .
