Table 1
1-hour Oral Glucose Tolerance Test (OGTT) After a 50-g oral glucose load in pregnant women
Table 2
Criteria for Abnormal Result on 100-g, 3-Hour Oral Glucose Tolerance Test in Pregnant Women
Table 3
Define and differentiate between the following Postpartum Disorders:
Normal Range (Negative) Abnormal Range (Positive)
1 hour < 140 mg/dL 130 – 140 mg/dL
Blood Sample
National Diabetes Data Group
Criteria
Carpenter and Coustan Criteria
Fasting 105 mg/dL 95 mg/dL
1 hour 190 mg/dL 180 mg/dL
2 hours 165 mg/dL 155 mg/dL
3 hours 145 mg/dL 140 mg/dL
What defines a positive 3-hour glucose tolerance test result (failed result)? Two or more
threshold glucose levels on the 3-hour test must be met or exceeded.
Definition Signs and Symptoms
Management of the
Diagnosis
Postpartum
Blues
Short-lived
mood change
Sadness, weepiness, mood
swings, irritability that occurs
in the first few days to 10
days postpartum; lasts less
than two weeks
Family support,
uninterrupted rest, exercise,
adequate fluids, nutritious
meals
Table 4
Postpartum
Depression
Depression
occurring within
the first year
postpartum that
meets standard
diagnostic
criteria; lasts
longer than two
years
Crying, feeling sad,
overwhelmed, lack of interest
in daily activities, lack of
interest in infant, feeling sub-
inadequacy
Home support, therapy
Postpartum
Obsessive-
Compulsive
Disorder
Need to perform
repetitive
physical or
mental actions
Onslaught of intrusive
thoughts or rituals SSRIs and CBT
Postpartum
Psychosis
Psychotic
episode
(delusions or
break with
reality)
occurring within
the first year
after birth
Auditory and visual
hallucinations, various
unexplained behaviors, i.e.
smelling smoke
Immediate care i.e.
emergency room
Definition
Presentation
(include Signs and
Symptoms)
Management of the
Diagnosis
Puerperal
Fever
Temp. 100.4 F or
greater during
postpartum period
caused by bacterial
infection in the
reproductive tract or
breasts
Genital tract or wound
infections
breast engorgement,
dehydration, DVT
CBC w/ diff, urine
analysis, cultures,
radiology and/or
ultrasound.
Antimicrobial therapy
Postpartum
Hematoma
Collection of blood in
the vaginal, perineal,
pelvic, or abdominal
tissue, post childbirth
Evidence of blood loss:
Decrease hematocrit
Severe perineal and/or
rectal pain
Management varies on
size.
Small hematomas can
reabsorb; moderate to
large hematomas may
need I&D
Secondary
(delayed)
Postpartum
Hemorrhage
Excessive bleeding that
occurs between 24
hours after birth until
six weeks postpartum
Hemorrhage bleeding
Masses suspicious for
retained placental
fragments
Uterotonic agents:
ergonovine,
methylergonovine,
oxytocin, a prostaglandin
analog, or tranexamic
acid. Surgical referral for
suction evacuation to stop
bleeding
Sore Nipples
The most common
reasons for abandoning
exclusive breastfeeding.
Sore, painful, cracked.
infection: exudate,
increased erythema, pus,
or dry scab
Warm compresses, green
tea bag compresses,
coconut oil, hydrogel
dressing, nipple shields,
wash nipples with soap &
water once daily, topical
mupirocin, peppermint oil,
topical low dose steroids
for inflammation;
antibiotic: Miconazole for
C. albicans
Jennifer is a G2P1, 31-year-old pregnant female at 24 weeks EGA who has come to the clinic
for her 24-week prenatal visit and recommended screening tests. Jennifer’s one hour glucose test
result is 156 mg/DL. Her BP is 118/78 T 98.7 F, P 68, RR 18, fundal height is 25 cm, no urine/
protein in urine, weight is 145 lbs at 5 lbs increased from last visit 4 weeks ago, her height is 5’
5”.
Demographic Data
• 31-year-old-female
Mastitis
Acute inflammation of
the interlobular
connective tissue of the
breast that may include
an infection. S. aureus
is the main causative
bacteria.
Erythema, pain,
swelling, fever.
Pain described as sharp,
needlelike, with burning
sensation.
Symptoms associated
with infection: fever 101
F or greater, area red,
tender, and hot; muscle
aches & malaise,
elevated heart rate,
nausea, chills, red streaks
on the breast.
Feed or pump on the
affected side. Frequent
feedings, breast
compressions, topical
ricinoleic acid; heating
pad, castor oil,
Antibiotics:
First line: Dicloxacillin or
Flucloxacillin; Cephalexin
Second line: Clindamycin
or Bactrim DS
Breast
Abscess
A potential
complication of mastitis
r/t untreated, delayed,
inadequate, or incorrect
treatment for mastitis.
Abscess formation
increases with smoking.
Hard, red, and tender
area on the breast.
If incapsulated, must be
drained either surgically or
needle aspiration. Abscess
drainage should be
cultured to determine
antibiotic sensitivity.
Continue breast feeding
and/or pumping.
Subjective
Chief Complaint (CC): 31-year-old-female, G2P1 at 24 weeks EGA, presents to the clinic for a
routine follow up 24-week prenatal visit and recommended screen tests.
History of Present Illness (HPI): 31-year-old-female, G2P1 at 24 weeks EGA, presents to the
clinic for a routine follow up 24-week prenatal visit and recommended screening tests. The one-
hour glucose test result is 156 mg/dL; the patient has gained 5 lbs in the past 4 weeks; the fundal
height is 25 cm; and POCT urine dipstick is (-) for protein.
Past Medical History (PMH):
• Medical History:
o Denies history of HTN, diabetes, elevated cholesterol
o Denies complications with previous pregnancy
o Denies abnormal pap smears
• Hospitalizations:
o Spontaneous vaginal delivery: 2023- no complications
• Medications:
o Prenatal vitamin daily
• Allergies:
o No known drug allergies
o No know food allergies
• Immunizations:
o Influenza vaccine: 10/2024
o Covid Vaccines: 2021 & 2022
o HPV Vaccines: x3 doses at 12 years old
• Preventative Health Maintenance:
o PAP: last pap at 30 years
o Eye exams: every 2 years, last exam 2024
o Dentals exam & cleaning: last dental visit 1/2025
o STI screening: at 21 years old; 2020, and at each pregnancy diagnoses: 2023 & 2025
• Family History:
o Mother: hyperlipidemia
o Father: HTN, Hyperlipidemia
o Maternal Grandmother: hyperlipidemia
o Maternal Grandfather: HTN, Hyperlipidemia
o Paternal Grandmother: hyperlipidemia
o Paternal Grandfather: HTN, DM Type II
o Maternal great-grandmother: hyperlipidemia
o Maternal great-grandfather: HTN, Hyperlipidemia
o Paternal great-grandmother: Hypertension
o Paternal great-grandfather: HTN, DM Type II
• Social History:
o Nutrition: Eats a balanced diet and occasional take out
o Exercise: denies
o Denies history of illegal drug use
o Sexual history: 2 lifetime partners; 1 partner for the past 5 years
o Sexual intercourse with males
o History of STIs: denies
o Contraception: male condoms
o Menstrual history: 1st menstrual cycle at 13 years old
o Occupation: Elementary school teacher
o Caffeine: Green and black tea
o Smoking: denies cigarette and vaping
o Alcohol: 2-3 glasses a week prior to pregnancy
Review of Symptoms:
• General: denies fever/chills, (+) fatigue, (+) increased thirst
• Psychological: denies anxiety and depression
• Neurological: denies headaches and dizziness
• Eyes: denies blurry vision
• Ears: denies ringing in ears
• Nose, Mouth, and Throat: denies nasal congestion, dry mouth, sore throat
• Cardiology: denies chest pain
• Respiratory: denies shortness of breath
• Breast: denies breast pain
• Gastrointestinal: denies abdominal pain, nausea/vomiting, diarrhea, constipation, heartburn
• Genitourinary: denies burning; (+) frequency and urgency
• Musculoskeletal: denies muscle, joint, back pain
• Skin: denies itching
• Gynecological: Denies discharge, bleeding, pelvic cramping, leaking of fluids; denies
Braxton Hicks
• Heme/Lymph/Endo: denies heat/cold intolerance
Objective:
Vital signs: B/P: 118/78; HR: 68; T: 98.7 F; RR: 18
Pain: 0/10
Pre-pregnancy weight: 120 lb; Height: 65 inches; BMI: 20.0
Current weight 145 lbs
Pregnancy gain: + 5 lbs in 4 weeks
One hour glucose test result: 156 mg/dL. Positive result
POCT: Urine dipstick: (-) protein
Physical exam:
• Generalized: age appropriate, well developed, well-nourished, no acute distress
• Neurological: alert and oriented
• Cardiology: no swelling noted to BLE, no murmur
• Pulmonary: regular respiratory rate; chest symmetric, no wheezing
• Gastrointestinal: abdomen round; non-tender
• Musculoskeletal: upper and lower extremities, full range of motion; stable gait
• Integumentary: warm and dry
• Psychiatric: calm and cooperative
• Genitourinary: urine clear, no odor
• Gynecological: no vaginal redness or discharge noted
• Fundal height: 25cm (acceptable 22-26 cm)
OB Abdominal ultrasound:
• Intrauterine pregnancy singleton
• Presentation: Vertex
• Fetal cardiac activity present; HR 144
• Amniotic fluid appears adequate
• Fetal movements: Yes
• Fetal breathing movements: Yes
Differential Diagnosis
(1) Urinary tract infection:
• Positives: frequency, urgency, pregnancy
• Negatives: urine clear, no odor, no fevers/chills, no low abdominal/back pain
Final Diagnosis
(1) Gestational diabetes (GD):
• Positives: maternal age > 25, weight gain +5 lbs in 4 weeks, 1-hr glucose teat 156, fatigue,
increased thirst, increased urinary frequency and urgency
Plan:
Diagnostic testing
• Urine POCT in office: to r/o UTI: negative for nitrite and/or leukocyte
• NST: monitors fetal heart rate in response to their movement
• CBC: monitor WBC & platelets, can increase with GD.
• 3-hour 100-g OGTT Glucose challenge: to diagnose GD
Medications:
Continue: Prenatal vitamin: Take 1 tablet by mouth daily.
Vaccine: Tdap
Education:
• Normal weight pre-pregnancy: weight gain 1 lb /week during 2nd – 3rd trimester.
• Complications of GDM if noncompliant
o Maternal: Risk of high blood pressure, preeclampsia, pre-term labor, spontaneous abortion
o Fetus: microsomia, macrosomia (makes delivery difficult), still birth
o Newborn: elevated bilirubin causes jaundice, hypocalcemia, polycythemia, hypoglycemia
• Exercise 30 minutes daily 5 times a week, such as walking
• Limit carbohydrates
• Eat 3 meals and 2 snacks
• Monitor blood glucose at home 4-6 times per day: before meals, and 2 hours after
• 3-hour 100-g OGTT: in the morning after fasting overnight
• Management for Class GDMA1:
o diet, exercise, blood glucose monitoring
• Management for Class GDMA2
o Starting with Metformin 500mg by mouth once a day for one week, then increase to 500 mg
to twice a day to decrease side effects
o Can increase 500 mg every week to a maximum of 2500 ng
o Most common side effects of Metformin: abdominal pain & diarrhea
• Insulin
o Recommended for BMI > 40
o Serious risk factor is hypoglycemia which can lead to coma or death if not treated
immediately
o Symptoms of hypoglycemia: shaking, sweating, agitation, rapid heart rate, clammy skin
o Blood glucose < 80 should be treated with 15 gm of glucose
• Monitor for type DM and insulin resistance after delivery
Referral/Follow-up
• Referral to dietician or diabetes educator- if positive
• Week 28 visit:
o NST:
o Urogynecology for pelvic floor evaluation, exercises
o Transabdominal ultrasound
o Amniotic fluid index (AFI)
o POCT: urine dipstick
• RSV: recommended at 28 weeks to protect the infant from RSV
• Tdap: recommended between 27-36 weeks to protect against pertussis (whooping cough)
Health Maintenance:
• Vision exams: every 2 years- 2026
• Dental exams/cleaning: 2 per year- 7/2025
• Pap: 33 years old
• Vaccines: 10/2025: annual influenza
