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Two screening approaches are used to detect gestational diabetes, the 1-step and 2-step methods. The 1-step method is diagnostic and consists of a 75-g, 2-hour oral glucose tolerance test (OGTT). The 2-step method consists of a 50-g, 1-hour glucose challenge test, followed by a 100-g, 3-hr OGTT if initial test results are positive. All pregnant patients should be screened for gestational diabetes between 24 and 28 weeks' gestation unless pregestational diabetes is present. Lifestyle modifications are fundamental to management, and most patients are able to control blood glucose levels with these alone. Persistent hyperglycemia should be managed with drugs. Currently, insulin is the only drug approved by the Food and Drug Administration (FDA) for gestational diabetes management. Metformin or glyburide can be reasonable alternatives. For patients who require drugs, antepartum fetal surveillance is recommended starting at 32 weeks' gestation. The American College of Obstetricians and Gynecologists (ACOG) recommends delivery at 39 0/7 to 40 6/7 weeks' gestation for patients with gestational diabetes controlled with diet alone. Earlier delivery is recommended for patients with gestational diabetes controlled with drugs, at 39 0/7 to 39 6/7 weeks' gestation. Patients with gestational diabetes are at increased risk of type 2 diabetes later in life. These patients should be screened for prediabetes and diabetes between 4 and 12 weeks postpartum with a 75-g, 2-hour OGTT. Postpartum patients with a normal OGTT result should be screened every 1 to 3 years thereafter. [ABSTRACT FROM AUTHOR]

Fetal growth restriction (FGR) is defined as an ultrasound (US)-determined estimated fetal weight or abdominal circumference less than the 10th percentile according to a population level reference curve. FGR affects up to 10% of pregnancies. Fetuses with FGR are at increased risk of intrauterine mortality and, postnatally, neonatal intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress, hypoglycemia, and suboptimal neurologic, behavioral, and cognitive development. In early-onset FGR (ie, less than 32 weeks' gestation), a detailed US examination is recommended. When FGR is accompanied by polyhydramnios and/or fetal anomalies, genetic testing should be obtained, including chromosomal microarray analysis. The timing of delivery strategy should be based on the severity of growth restriction and findings on fetal tests of well-being (eg, nonstress testing, umbilical artery Doppler velocimetry). No routine prevention strategies are recommended. However, it has been shown that daily low-dose aspirin (ie, 81 mg/day) reduces the risk of FGR when taken by patients with a high risk of preeclampsia. [ABSTRACT FROM AUTHOR]

Patients at increased risk of stillbirth should be assessed with antepartum fetal surveillance (AFS) tests at regular intervals. In general, AFS should begin at the gestational age at which delivery would be considered. Most surveillance tests are performed weekly, but more frequent testing should be considered for patients with high-risk conditions. AFS tests include fetal movement monitoring, nonstress test, contraction stress test, biophysical profile, and modified biophysical profile. Umbilical artery Doppler velocimetry is used in the setting of fetal growth restriction. Abnormal test results should prompt additional assessment and consideration of delivery. Normal test results can provide reassurance about fetal well-being, but cannot predict the likelihood of acute incidents, such as placental abruption and umbilical cord infarction. [ABSTRACT FROM AUTHOR]

Vaginal bleeding in the first trimester is a common concern during pregnancy. The amount of bleeding and associated symptoms, such as nausea and vomiting, can be of prognostic value. Timely evaluation with vital signs, physical examination, laboratory tests (eg, Rh factor, hemoglobin and possibly progesterone levels), and pelvic ultrasound (US) can distinguish among viable pregnancy, nonviable pregnancy, intrauterine pregnancy (IUP) of uncertain viability, and pregnancy of unknown location. Serial pelvic US can be obtained in patients with IUP of uncertain viability after 11 to 14 days, and in pregnancy of unknown location in as little as 48 hours. Quantitative human chorionic gonadotropin (hCG) levels are of minimal clinical utility after IUP is visualized on US. Serial quantitative hCG levels should be measured in patients with pregnancy of unknown location. After an early pregnancy loss has been identified, as long as the patient is hemodynamically stable, options include expectant, medical, and surgical management. The treatment plan can be guided by shared decision-making. Ectopic pregnancy can be managed surgically via laparoscopy, medically with methotrexate, or expectantly (in certain circumstances). Progesterone for patients with early pregnancy bleeding and no history of miscarriage likely is of no benefit. [ABSTRACT FROM AUTHOR]

Two screening approaches are used to detect gestational diabetes, the 1-step and 2-step methods. The 1-step method is diagnostic and consists of a 75-g, 2-hour oral glucose tolerance test (OGTT). The 2-step method consists of a 50-g, 1-hour glucose challenge test, followed by a 100-g, 3-hr OGTT if initial test results are positive. All pregnant patients should be screened for gestational diabetes between 24 and 28 weeks' gestation unless pregestational diabetes is present. Lifestyle modifications are fundamental to management, and most patients are able to control blood glucose levels with these alone. Persistent hyperglycemia should be managed with drugs. Currently, insulin is the only drug approved by the Food and Drug Administration (FDA) for gestational diabetes management. Metformin or glyburide can be reasonable alternatives. For patients who require drugs, antepartum fetal surveillance is recommended starting at 32 weeks' gestation. The American College of Obstetricians and Gynecologists (ACOG) recommends delivery at 39 0/7 to 40 6/7 weeks' gestation for patients with gestational diabetes controlled with diet alone. Earlier delivery is recommended for patients with gestational diabetes controlled with drugs, at 39 0/7 to 39 6/7 weeks' gestation. Patients with gestational diabetes are at increased risk of type 2 diabetes later in life. These patients should be screened for prediabetes and diabetes between 4 and 12 weeks postpartum with a 75-g, 2-hour OGTT. Postpartum patients with a normal OGTT result should be screened every 1 to 3 years thereafter., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Vaginal bleeding in the first trimester is a common concern during pregnancy. The amount of bleeding and associated symptoms, such as nausea and vomiting, can be of prognostic value. Timely evaluation with vital signs, physical examination, laboratory tests (eg, Rh factor, hemoglobin and possibly progesterone levels), and pelvic ultrasound (US) can distinguish among viable pregnancy, nonviable pregnancy, intrauterine pregnancy (IUP) of uncertain viability, and pregnancy of unknown location. Serial pelvic US can be obtained in patients with IUP of uncertain viability after 11 to 14 days, and in pregnancy of unknown location in as little as 48 hours. Quantitative human chorionic gonadotropin (hCG) levels are of minimal clinical utility after IUP is visualized on US. Serial quantitative hCG levels should be measured in patients with pregnancy of unknown location. After an early pregnancy loss has been identified, as long as the patient is hemodynamically stable, options include expectant, medical, and surgical management. The treatment plan can be guided by shared decision-making. Ectopic pregnancy can be managed surgically via laparoscopy, medically with methotrexate, or expectantly (in certain circumstances). Progesterone for patients with early pregnancy bleeding and no history of miscarriage likely is of no benefit., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

Patients at increased risk of stillbirth should be assessed with antepartum fetal surveillance (AFS) tests at regular intervals. In general, AFS should begin at the gestational age at which delivery would be considered. Most surveillance tests are performed weekly, but more frequent testing should be considered for patients with high-risk conditions. AFS tests include fetal movement monitoring, nonstress test, contraction stress test, biophysical profile, and modified biophysical profile. Umbilical artery Doppler velocimetry is used in the setting of fetal growth restriction. Abnormal test results should prompt additional assessment and consideration of delivery. Normal test results can provide reassurance about fetal well-being, but cannot predict the likelihood of acute incidents, such as placental abruption and umbilical cord infarction.

Fetal growth restriction (FGR) is defined as an ultrasound (US)-determined estimated fetal weight or abdominal circumference less than the 10th percentile according to a population level reference curve. FGR affects up to 10% of pregnancies. Fetuses with FGR are at increased risk of intrauterine mortality and, postnatally, neonatal intraventricular hemorrhage, necrotizing enterocolitis, respiratory distress, hypoglycemia, and suboptimal neurologic, behavioral, and cognitive development. In early-onset FGR (ie, less than 32 weeks' gestation), a detailed US examination is recommended. When FGR is accompanied by polyhydramnios and/or fetal anomalies, genetic testing should be obtained, including chromosomal microarray analysis. The timing of delivery strategy should be based on the severity of growth restriction and findings on fetal tests of well-being (eg, nonstress testing, umbilical artery Doppler velocimetry). No routine prevention strategies are recommended. However, it has been shown that daily low-dose aspirin (ie, 81 mg/day) reduces the risk of FGR when taken by patients with a high risk of preeclampsia., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)

32 patients with different cardiac lesions underwent examinations by magnetic resonance imaging (MRI). In order to reduce moving artefacts measurements were carried out with ECG-triggering. It was possible to make visible precise anatomical details of the heart in cases of congenital diseases, aneurysms, myocardial infarction etc. Important advantages are contrasted with obvious disadvantages.

When using the spin-echo technique natural, ligament and menisci have practically nearly no signal. Degenerative lesions, lesions of cartilage, and osteochondrosis dissecans are visible. After ligament plastic the bore canal for the alloplastic ligament is visible. The advantages of MRI are pointed out.

In 10 pts. with mitral valve lesions dense spontaneous echographic contrast was found within the left atrium by transoesophageal echocardiography. Because of the neurologic symptoms some of the patients also had (transitoric ischemic attacks, embolism) left atrial thrombosis was suspected. The echographic phenomenon of spontaneous left atrial contrast was further examined by magnetic resonance imaging in all 10 pts. Using the spin-echo-mode the multi-echo-imaging showed dense signals in the second echo and no or few left atrial signals in the first echo in 8/10 pts. In 2/10 pts. there were no increased signals in left atrium. The missing presence of the increased signals in the first echo excluded thrombosis of the left atrium and proved blood flow effects.

Patients with a corpus carcinoma were examined by magnetic resonance imaging before and after application of the paramagnetic contrast agent Gd-DTPA. The images were obtained by spin echo technique with the repetition times 0.5 s or 1.8 s and the echo times 35/70 ms. The dosis of the contrast agent was 0.1 mmol per kg body weight. The contrast between myometrium and tumour increased after injection of the contrast agent and structures within the tumour can be better differentiated. The pelvic organs (bowel and urinary bladder) can be seen in greater detail. Images taken with short repetition times after application of Gd-DTPA show greater contrast than pictures picked up with the same imaging parameters without contrast agent. Furthermore, there is an improvement compared with images taken with long repetition times.

Magnetic resonance tomography enables sensitive and specific three dimensional imaging processes in the bulbus, the soft parts of the orbita and the optic foramen as well as their relation to intracerebral structures. Besides a very exact imaging of the morphology it is also possible to characterise the tissue, this being a decisive factor in arriving at a correct diagnosis.

Noninvasive MRI of the knee joint yields a great deal of information on soft parts (ligaments, capsule, free fluid, menisci, cartilage) and bones. The image is changed by intraarticular administration of air and of small quantities of fluids supply many signals, such as gadolinium DTPA solution. The results and possibilities of application are discussed.

MT tomography offers an excellent opportunity of indirectly proving that traumatic exairesis of a nerve root has occurred. If a nerve root pocket is "empty" as a result of the exairesis, it is filled completely with central nerve fluid CNF and is then easily visualised.