بخشی از پاورپوینت
اسلاید 1 :
By the name of God
غربالگری و مدیریت دیابت حاملگی
اسلاید 3 :
چه بیماریهایی را باید غربالگری نمود؟
اسلاید 5 :
آیا دیابت بارداری نیاز به غربالگری دارد؟
Maternal morbidity
Early :
Preeclampsia/gestational hypertension
Operative delivery
Induction of labour
Placental abruption? Postpartum hemorrhage? Postpartum infection?
Late :
Diabetes type II
Hypertension?
Perinatal-neonatal morbidity/morbidity
Birth trauma
Preterm birth
Still birth, Perinatal death
Macrosomia
Neonatal respiratory problems Hypoglycemia
metabolic complications (hypoglycemia, hyperbilirubinemia, hypocalcaemia)
Long term sequelae of in utero exposure
Obesity
Diabetes type II
Dyslipidaemia?
Hypertension?
impaired fine and gross motor functions, and higher rates of inattention and/or hyperactivity
اسلاید 6 :
آیا کلیه ی زنان باردار می بایست جهت بررسی ابتلا به دیابت بارداری غربالگری شوند؟
اسلاید 7 :
Risk factor for gestational diabetes
A family history of diabetes, especially in first degree relatives
Pre pregnancy weight ≥110 percent of ideal body weight or body mass index over 30 kg/m2 or significant weight gain in early adulthood , between pregnancies, early to mid pregnancy
Age greater than 25 years
Previous delivery of a baby greater than 4.1 kg
Personal history of abnormal glucose tolerance
Member of an ethnic group with higher than the background rate of type 2 diabetes (e.g. African-American, Native American, South or East Asian, Pacific Islander).
Previous unexplained prenatal loss or birth of a malformed child
Maternal birth weight greater than 4.1 kg or less than 2.7 kg
Glycosuria at the first prenatal visit
Polycystic ovary syndrome
Current use of glucocorticoids
اسلاید 8 :
کدام آزمون برای غربالگری دیابت بارداری مناسب است؟
اسلاید 12 :
GDM – Two Step Screening
Two Step Screening
Do a Random Glucose Challenge Test (GCT)
50 grams of oral glucose any time of day
1 hour post test for plasma glucose (1 hr PG)
Result > 200 mg% - Dx of GDM confirmed
Result > 140 mg% - Dx of GDM suspected
140 to 200 – We need OGTT (100 g) to confirm
One Step Screening
OGTT – 2 hours after 75 g of oral glucose
www.drsarma.in
اسلاید 13 :
Glucose Challenge Test (GCT)
www.drsarma.in
اسلاید 14 :
OGTT –100g –3 hour Test
www.drsarma.in
Two abnormal
Value is necessery
اسلاید 15 :
OGTT –75g –2 hour Test
www.drsarma.in
One abnormal
Value is Adequate
اسلاید 16 :
Impact of early detection & treatment
Australian Carbohydrate Intolerance Study in Pregnant Women
ACHOIS
اسلاید 17 :
$60,506 Cost
9.7 additional induction labour
8.6 more admission to NICU
To avoid 3.2 Prenatal morbidities and mortalities
For every 100 women treated for mild GDM
اسلاید 20 :
Conclusion
For every 100,000 pregnancies screened using the IADPSG recommendations, 27 QALYs are gained compared with the current standard of care at an additional cost of $15,265,992.
The incremental cost-effectiveness ratio(ICER) is $565,407 per QALY gained.
When post delivery care was not accomplished, the IADPSG strategy was no longer cost-effective.
