Historical and statistical aspects of risk groups analysis and testing in the context of gestational diabetes mellitus
Maja MacuraStefan DugalićJovana TodorovićBojana GutićMiloš MilinčićDragana BozicMilica StojiljkovićIvan SoldatovićIgor PantićMilan PerovićBiljana ParapidMiroslava Gojnić
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Abstract:
In order to enhance cost-benefit value of the gestational diabetes mellitus screening (GDM) the concept of universal screening i.e., screening of all pregnant women for gestational diabetes, has mostly been abandoned in favor of the concept of selective screening. Selective screening implies that only women with risk factors are being screened for GDM. However, some recent studies have shown that with the application of the selective screening approach, some women with GDM may not receive proper and timely diagnosis. This review addresses the pros and cons of both concepts. It will also discuss screening methods and methods of preparation and performance of oral glucose tolerance test and the interpretation of its results.Keywords:
Screening test
A triplet pregnancy is described in which there was a second trimester abortion of one fetus at 16 weeks' gestation. A cervical cerclage was placed, and tocolysis was used. The other two triplets were delivered 131 days later (at 35 weeks' gestation) by cesarean section. Both infants survived. This case is unique in the literature.
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Aims: Abaut 1–5% of all pregnant women develop an abnormal glucose intolerance during their pregnancy.The most commonly used method for screening is 50 gr. Glucose challenge test. The possibility of a positive 50 gr. glucose challenge test is until 14%.
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Abstract Three hundred and thirty‐nine cases of multiple gestation underwent prenatal diagnosis by amniocentesis. The spontaneous abortion rate (to 28 weeks) in this group was 3.57 per cent compared with our singleton abortion rate of 0.60 per cent. The perinatal mortality rate (PMR) and prematurity rate were not different from the singletons, and compared favourably with the PMR reported in the literature for multiple gestations which did not undergo any intervention during pregnancy. This increased abortion rate following amniocentesis may only represent the increased natural loss rate in multiple gestations, and not indicate any increased risk added by the procedure.
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Abstract Objective . The aim was to determine the chorionic and amniotic types in multifetal pregnancies with transvaginal ultrasonography at very early stage of gestation. Study design . Twenty-one spontaneous multifetal pregnancies were scanned transvaginally before 8 weeks' gestation (four of them from 4th week). The chorionic and amniotic type was determined ultrasonographically. All twin gestations had postpartum pathologic evaluation of the placenta and histologic determination of the chorionic and amniotic type. Results . Ultrasonographic evaluation of the 21 pregnancies demonstrated 20 twin and 1 triplet gestation. Four of the twin pregnancies were monochorionic-diamniotic. Triplet was monochorionic-triamniotic (spontaneously aborted in 8th week of gestation). In all 20 twin pregnancies, transvaginal ultrasonography correctly predicted the chorionic and amniotic type before 8 weeks of gestation. Conclusion . Transvaginal ultrasonography allows a reliable, simple and rapid determination; the dichorionic twin pregnancy in 4 weeks, monochorionic in 5 weeks, and differentiation of mono-or diamniotic in 7 weeks of gestation.
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In order to enhance cost-benefit value of the gestational diabetes mellitus screening (GDM) the concept of universal screening i.e., screening of all pregnant women for gestational diabetes, has mostly been abandoned in favor of the concept of selective screening. Selective screening implies that only women with risk factors are being screened for GDM. However, some recent studies have shown that with the application of the selective screening approach, some women with GDM may not receive proper and timely diagnosis. This review addresses the pros and cons of both concepts. It will also discuss screening methods and methods of preparation and performance of oral glucose tolerance test and the interpretation of its results.
Screening test
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Screening test
Glucose tolerance test
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Fetal macrosomia
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( Am J Obstet Gynecol . 2016;215:243.e1–243.e7) Gestational diabetes mellitus (GDM) can lead to other pregnancy-related adverse effects such as macrosomia and birth trauma. To prevent these maternal and neonatal risks, labor is usually induced at term in women with GDM. However, the risks and benefits of induction of labor (IOL) have been inadequately analyzed. The objective of this study was to assess the correlation between IOL, gestational age and rates of cesarean delivery (CD) in women who have GDM.
Cesarean delivery
Fetal macrosomia
Labor Induction
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A screening test for gestational diabetes should be capable of identifying for definitive (glucose tolerance) testing a large proportion of women who have the disease (sensitivity), while not identifying women for definitive testing who do not have the disease (specificity). Methods of screening include selecting patients with historical risk factors, hemoglobin A1c, fasting glucose concentrations, and the 50 g 1-hour glucose-screening test. Glucose concentrations with the latter vary with time of day and time after the last meal, and are poorly reproducible. Interposing a screening test prior to glucose tolerance testing trades ease of administration and reduced costs for the possibility of not identifying some women who have gestational diabetes.
Screening test
Glucose tolerance test
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Screening test
Glucose tolerance test
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