A case in point
This patient arrived at our office billed as having a uterusthat was large for dates. She seemed to have regularperiods prior to her well-recalled last menstrual period,which suggested her to be 32 weeks. The BPD and HCwereappropriate for 33 weeks, as well as the femur. The
AC was in sync for 34 weeks and the
EFW was in the 90thpercentile.
The patient had a previous delivery of an 4.5 kg baby.Her 1-hour glucose screen was “positive,” but her fullglucose
tolerance test at 27 weeks was
“negative.” Also,the above scan was productive of a single vertical pocket
of 7.5 cm, the stomach was large, and the bladder wasgenerous in size.
The combination of a large baby, body-to-head dis-proportion, a large bladder and generous amniotic fluid(suggesting polyuria) made this patient seem like a genuine grade A gestationaldiabetic despite her negativeglucose tolerance test. The 1-hour glucose screen was
repeated, which was 150 mg%.Some gestational diabetics are late bloomers, and allthey need is a larger dose of anti-insulin factors springingfrom the placenta (like human placental lactogen) to kickthem into bona fide glucose intolerance. What is perhapsdebatable is whether knowing this will make a majordifference in outcome.
Nevertheless, altering one’s diet
for the better cannot be a badthing.