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Literature review current through: Jan 2020. | This topic last updated: Oct 23, 2019.

Introduction: Treatment of gestational diabetes can improve pregnancy outcome. Many women can achieve euglycemia with nutritional therapy alone, but up to 30 percent will require drug therapy [1]. The general approach to treatment of gestational diabetes mellitus will be reviewed here. Screening, diagnosis, and obstetric management are discussed separately. (See “Diabetes mellitus in pregnancy: Screening and diagnosis” and “Pregestational (preexisting) diabetes mellitus: Obstetric issues and management”.)

The above is a GDM article from UpToDate. This article speaks to the diagnosis, complications of, and management of gestational diabetes. I chose this article because gestational diabetes was something that I began to encounter from day 1 in Ob/Gyn. I wanted to brush up on the details and make sure I knew how to diagnose and monitor for various types of GDM. Intrapartum glucose management is an important part of intrapartum care ind GDM, and it was something that I witnessed in nearly ¼ of patients in L&D. Prevalence aside, diabetes is an increasingly common occurrence among patients in all specialties, so I wanted to get a better understanding of the long-term complications, not just for mother but also baby. GDM greatly increases the risk of ongoing DM2 for mothers as well as insulin and glucose imbalances in neonates that will need monitoring and correcting.

             During my first evaluation, I presented an H&P of an Ob case with GDMA1 during my first overnight Ob shift in L&D. My site evaluator did not have much critical feedback for me, but we did have a good conversation about the different types of diabetes that might present in pregnancy, how they are managed throughout pregnancy, and how to manage intrapartum blood glucose. Things I could add to my history taking and H&P’s are further exploration of social history, especially in Ob/Gyn patients. I forgot to document asking my patient if they feel safe at home, since domestic violence and various forms of abuse need to be considered in vulnerable populations such as pediatrics, geriatrics, and pregnant patients. This is something that I will always remember to ask and document moving forward.

Self-Reflection:

The last 5 weeks have presented a unique set of challenges for me, both as a new student and a male trying to get his bearings in female health. At Woodhull I did not see a very high volume of patients day-to-day, but I did encounter some very unique and engrossing cases, especially in Labor & Delivery. There is still much for me to learn, especially about pharmaceutical management of intrapartum care.            Although it might seem very basic, I learned a lot about how to present myself to patients and how to be both confident as well as sensitive to a patient’s preferences during interview and physical exam. As this is my first rotation, it still feels odd to be regarded by my patients as someone who supposedly knows that their doing.

Something I observed very early on is that a lot of practitioners fall back on routine in generating their H&P’s and documentation. This sense of routine is good in terms of timeliness and consistency, but it leaves some patients uninformed or confused about the results of their exam, their prognosis, or reasons for follow-up.

I know that I am new to healthcare, and I may feel very differently about this in 5 or 10 years, but it does seem that a lot of practitioners treat the patients themselves as just another part of their routine and don’t stop to make sure patients understand their diagnoses, treatment options, and prognoses. This becomes especially apparent when practitioners use clinical language instead of layman’s terminology that patient’s not only struggle to understand what is being communicated, but they are also likely to forget much of the conversation by the time they leave the clinic. This can create confusion and anxiety for some patients. I would like to assume that I will be a conscientious communicator towards patients throughout my career, but it will likely be an active effort on my part to make sure that I do not become complacent in these areas.

My bedside manner still needs honing. If anything, I tend to overthink how I am going to approach each patient, how I will word each question or statement, and that can set a tone that is too hesitant and potentially nervous. After the first few weeks, I started to settle into a groove that was effective in establishing a rapport and trust with patients while also hitting the pertinent aspects of my HPI, ROS, and physical exam. This also pays dividends when I can tell that patients are really listening attentively during counseling and education. This can be something as simple as reminding patients to try to ambulate and use their incentive spirometers after surgery or to follow up after one month of trying a new form of birth control, but it can really shape the patients prognosis when they are attentive and compliant with education, medication, and follow-ups.