UW vs Crash step 2

[BabyPsychDoc]

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Different info given by the two resources. Practising medicine in the UK, I do not know which one to believe (since we do something entirely different over here). Any help from my US counterparts?

1. Glucose screen in pregnancy. UW - 50 g OGTT screen, 100 g OGTT confirm. Crash - fasting serum glucose screen AND undefined OGTT. Which one is right?

2. Gestational age cut off for D&C (as opposed to induced labour). 14 weeks Crash, 16 weeks UW.

3. HIV screen. Do not remember on UW (did all qs). Crash says only high risk. UK screens every pregnant woman at first antenatal appointment.

4. Threatened abortion - treated with bed rest? Really? Why, if the majority of spontaneous miscarriages during the first trimester are due to fetal chromosomal abnormalities anyway?

Thank you in advance.

 

[Babycatcher2B]

Different info given by the two resources. Practising medicine in the UK, I do not know which one to believe (since we do something entirely different over here). Any help from my US counterparts?

1. Glucose screen in pregnancy. UW - 50 g OGTT screen, 100 g OGTT confirm. Crash - fasting serum glucose screen AND undefined OGTT. Which one is right?

2. Gestational age cut off for D&C (as opposed to induced labour). 14 weeks Crash, 16 weeks UW.

3. HIV screen. Do not remember on UW (did all qs). Crash says only high risk. UK screens every pregnant woman at first antenatal appointment.

4. Threatened abortion - treated with bed rest? Really? Why, if the majority of spontaneous miscarriages during the first trimester are due to fetal chromosomal abnormalities anyway?

Thank you in advance.

Question 1: I believe that pts who are at high risk of DM may get a fasting blood glucose at the first prenatal visit (i.e. screening for preexisting DM); However, all pts get the 50 g glucose tolerance test to screen for b/t 24-28 wks (screening for gestational diabetes). Also, when you think about it a pt that gets the OGTT is actually fasting before they drink the nasty stuff and they always measure the fasting glucose before the drink the nasty stuff. So i believe thats what they mean by fasting blood glucose and OGTT. Also if your fasting glucose is greater than 95 (taken in the context of the OGTT), then that also makes a diagnosis of gestational DM (in addition to blood levels above a certain point after so many hours).

Question 2: I don't think 14 or 16 wks isn't a big difference for cutoffs. Important to remember is early on (i.e. first trimester) = D&C.

Question 3: It is indeed high risk pts who ar screened. Therefore it depends on the pt population that you are treating. While doing my Ob/Gyn clerkship we saw basically underserved African American, low socioeconomic women. I.E. thats a high risk population. So we screened everyone.

Question 4: I believe the from reading USMLE World, (I obviously have a good memory and it is scary that I remember this) that is is not been proven that best rest improves anything for threatened Abs. But physicians tell pts to do bed rest, so the pt won't feel like it is their fault, if spontaneos abortions does occur.

Correct me or add anything if I may be incorrect.

 

[flumazenil]

I think UW said to get bed rest depending on maternal and fetal condition- if both are okay- then do bed rest and AVOID heavy activity..aka sex..so if spontenous rupture does occur...they wont feel bad for bonin..