Screening and diagnosis of gestational diabetes mellitus by IADPSG criteria

Background: GDM is a complex clinical entity and its screening, diagnosis, and management warrants attention. With this issue in mind, we aimed to study the prevalence of gestational diabetes mellitus in the antenatal group of patients attending tertiary hospital in New Delhi and its association with maternal outcome.Methods: 300 pregnant patients were enrolled in the first trimester and RBS (random blood sugar) was done. Those who had RBS >200mg/dl were labelled as overt diabetes and excluded from the study. The patients who were screened negative in phase 1 of screening were subjected to the next phase of screening at 24-28 weeks of gestation with 2-hour 75g OGTT using IADPSG criteria. Those who were diagnosed as GDM were followed in the antepartum, intrapartum and postpartum period.Results: The prevalence of overt diabetes and GDM in the study population is 1.33% and 13.33%. The prevalence of gestational hypertension, pre-eclampsia, chronic hypertension, polyhydramnios was 15%, 5%, 5%, 7.5% respectively. Normal and instrumental vaginal delivery was in 50 %, 5% patients respectively and 45 % had the caesarean section.Conclusions: The single step OGTT with lower threshold value cut-offs and single abnormal value for the diagnosis of GDM as advocated by IADPSG seem to be effective as it helps to screen and diagnose GDM at the same time as a single step procedure and thus more cost-effective.

Chronic Abruption In Early Second Trimester Mimicking Partial Mole - A Rare Case Report

Placental abruption is known as one of the most serious complications in pregnancy with detrimental effect on both the mother and the fetus. The clinical presentation and the ultrasound findings of this condition vary to a large extent as can be depicted from our case report. We report a rare case of a 30-year-old, G3P2L2 at 4 months of gestation, who presented with the complaints of dark altered bleeding along with pain lower abdomen for 1 day. Ultrasound findings were a dead fetus of 19 weeks 2 days with diffusely enlarged placenta with multiple cystic areas suggestive of intrauterine demise with partial mole. This case report is important as chronic placental abruption in the second trimester is rare, and a high index of suspicion is imperative to differentiate it from other conditions such as partial mole.