Aims To review postpartum glucose tolerance in women with gestational diabetes and evaluate the role of formal 75 g oral glucose tolerance testing vs. fasting plasma glucose in screening for persistent abnormalities.Methods Retrospective study of 985 pregnancies over a 10 year period in a mixed ethnic cohort of women who underwent follow-up glucose tolerance testing at 6 weeks postpartum. Diagnosis obtained by oral glucose tolerance test was tested against that from the fasting plasma glucose value.Results There were 272 abnormal postpartum oral glucose tolerance test results (27.6%), with 109 women identified as having frank diabetes. Eleven of these (10%) had fasting plasma glucose £6.0 mmol ⁄ l, as did 62 of 114 cases of impaired glucose tolerance. A fasting plasma glucose concentration of ‡6.1 mmol ⁄ l correctly identified abnormal glucose tolerance in 199 of 272 cases (sensitivity 0.73). South Asian women were much more likely to have persistent abnormalities of glucose tolerance than were Europeans (32 vs. 15%, v 2 P < 0.0001).Conclusions A postpartum fasting plasma glucose measurement alone is not sensitive enough in our population to classify glucose tolerance status accurately. A formal postpartum oral glucose tolerance test is therefore needed to facilitate early detection and treatment.Diabet. Med. 27, 650-654 (2010)
Background
In 2007 the Royal College of Obstetricians and Gynaecologists (RCOG) recommended that women with genital tract trauma sustained during vaginal birth should undergo a systematic assessment including a rectal examination to assess the severity of damage prior to suturing.
Objectives
To evaluate the impact of RCOG guidance on the proportion of women receiving a systematic examination prior to suturing of genital tract trauma and assess the proportion of severe perineal trauma identified.
Methods
A random sample of obstetric records were reviewed for the three years before (2004-2006) and following College guidance (2008-2010) to determine the proportion of women with second degree tears who had undergone a pre-repair systematic examination. Prospectively collected data on all third and fourth degree tears were examined within the study years.
Results
From 2004 to 2006, 3% of women had documented evidence of a pre-repair systematic assessment, this increased to 33% between 2008 and 2010. Third degree tears were identified in 1% (189/13,880) of women between 2004 and 2006 and 2% (345/14,654) between 2008 and 2010. The rate of fourth degree tears was unchanged (0.1%).
Conclusions
RCOG guidance on pre-repair examination led to an increase in the proportion of women undergoing a pre-repair systematic assessment including rectal examination, this was associated with doubling of the proportion of severe perineal trauma identified. Work to increase the rate of documented pre-repair systematic examination may increase the identification of severe trauma further.
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