Shannon Clark, MD, FACOG

#stitch with @Trinidee | Lifestyle 🍒 Go to my diabetes playlist for more info! What causes GD? The body produces a hormone called insulin that keeps blood sugar levels in the normal range. During pregnancy, higher levels of pregnancy hormones can interfere with insulin. Usually the body can make more insulin during pregnancy to keep blood sugar normal. But in some people, the body cannot make enough insulin during pregnancy, and blood sugar levels go up. This leads to GD. What are the risk factors for GD? Several risk factors are linked to GD, including: being overweight or obese being physically inactive having GD in a previous pregnancy having a very large baby (9 pounds or more) in a previous pregnancy having high blood pressure having a history of heart disease having polycystic ovary syndrome (PCOS) GD also can develop in people who have no risk factors. When a person has GD, their body passes more sugar to her fetus than it needs. With too much sugar, her fetus can gain a lot of weight. A large fetus (weighing 9 pounds or more) can lead to complications for the patient, including: labor difficulties cesarean birth heavy bleeding after delivery severe tears. How do I track blood sugar levels? You will use a glucose meter to test your blood sugar levels. This device measures blood sugar from a small drop of blood. Keep a record of your blood sugar levels and bring it with you to each prenatal visit. Blood sugar logs also can be kept online, stored in phone apps, and emailed to your ob-gyn. Your blood sugar log will help your obgyn provide the best care during your pregnancy. Will I need to take medication to control my GD? For some people, medications may be needed to manage GD. Insulin is the recommended medication during pregnancy to help patients control their blood sugar. Insulin does not cross the placenta, so it doesn’t affect the fetus. Your ob-gyn should teach you how to give yourself insulin shots with a small needle. In some cases, your ob-gyn may prescribe a different medication to take by mouth. If you are prescribed medication, you will continue monitoring your blood sugar levels as recommended. Your ob-gyn should review your glucose log to make sure that the medication is working. Changes to your medication may be needed throughout your pregnancy to help keep your blood sugar in the normal range. Will I need tests to check the health of my fetus? Special tests may be needed to check the well-being of the fetus. These tests may help your ob-gyn detect possible problems and take steps to manage them. These tests may include the following: Fetal movement counting (“kick counts”)—This is a record of how often you feel the fetus move. A healthy fetus tends to move the same amount each day. You should contact your ob-gyn if you feel a difference in your fetus’s activity. Nonstress test—This test measures changes in the fetus’s heart rate when the fetus moves. The term “nonstress” means that nothing is done to place stress on the fetus. A belt with a sensor is placed around your abdomen, and a machine records the fetal heart rate picked up by the sensor. Biophysical profile (BPP)—This test includes monitoring the fetal heart rate (the same way it is done in a nonstress test) and an ultrasound exam. The BPP checks the fetus’s heart rate and estimates the amount of amniotic fluid. The fetus’s breathing, movement, and muscle tone also are checked. A modified BPP checks only the fetal heart rate and amniotic fluid level. #gestationaldiabetes #pregestationaldiabetes #diabetes

Someone PLEASE find out who these people are!!! They need their own reality TV show! This is better than any medical TV drama! UPDATE! @laanoah1k and @NiyaaaDenee💕 ! #waterbroke #comedy #funnyvideo #birth #childbirth #labor #waterbreaks #greenscreenvideo

OP Asil Sivahc Did this happen to you when you were in labor?! #obgyn #mfm #gas #labor #laboranddelivery #laboranddeliverynurse #birth #childbirth

DO NOT BUY THIS PRODUCT! #perinealmassage #perinealtear #perinealtearing #perinealtearprevention #perinealstretch #birth #childbirth #laboranddelivery

What is lightening? This is the sensation that the fetus has dropped lower and the head settles deep in your pelvis. Because the fetus isn't pressing on your diaphragm, you may feel “lighter.” Lightening can happen anywhere from a few weeks to a few hours before labor begin. OP @weirdjaime #lightening #birth #childbirth #laboranddelivery

OP @Kim Perry Go to my “induction” playlist for more info! #inducelabor #induction #inductionoflabor #birth #raspberryleaftea #childbirth #laboranddelivery #dates #castoroil #midwivesbrew

Pregnant patients should not have to suffer! #pelvicgirdlepain #symphysispubisdysfunction #pregnancy

There are many things to consider when planning a home birth. Per @ACOG: People should be informed that although planned home birth is assoc with fewer maternal interventions than planned hospital birth, it also is assoc with a more than 2-fold increased risk of perinatal death and a 3-fold increased risk of neonatal seizures or serious neurologic dysfunction. People should be informed that several factors are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes. These factors include: •appropriate selection of candidates for home birth •availability of a certified nurse–midwife, certified midwife or midwife whose education and licensure meet International Confederation of Midwives’ Global Standards for Midwifery Education, or physician practicing obstetrics within an integrated and regulated health system •ready access to consultation •access to safe and timely transport to nearby hospitals The Committee on Obstetric Practice considers the following to be absolute contraindications to planned home birth: •fetal malpresentation •multiple gestation •prior cesarean delivery Recent studies have found that when compared with planned hospital births, planned home births are associated with fewer maternal interventions, including labor induction or augmentation, regional analgesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery, and cesarean delivery. Planned home births also are associated with fewer vaginal, perineal, and third-degree or fourth-degree lacerations and less maternal infectious morbidity. These observations may reflect fewer obstetric risk factors among those planning home births compared with those planning hospital births. In the US, where selection criteria may not be applied broadly, intrapartum and neonatal deaths among low-risk persons planning home birth are more common than expected when compared with rates for low-risk persons planning hospital delivery. Planned home birth of a breech-presenting fetus is associated with an intrapartum mortality rate of 13.5 in 1,000 and neonatal mortality rate of 9.2 in 1,000. #homebirth

YOU CANNOT GET GESTATIONAL DIABETES ON TOP OF TYPE 1 OR 2 DIABETES! YOU DO NOT NEED TO BE SCREENED COR GESTATIONAL DIABETES IF YOU ARE ALREADY A TYPE 1 OR 2 DIABETIC! #diabetes #gestationaldiabetes #glucola

From ACOG: Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes—for both the pregnant patient and the fetus—that might differ from those in a younger pregnant population, even in healthy individuals with no other comorbidities. There are several studies that suggest advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. From UpToDate: Obstetric outcomes that occur with increased frequency in those of advanced age include early pregnancy loss, ectopic pregnancy, multiple gestation, placenta previa, protraction/arrest disorders, and cesarean birth. Severe maternal morbidity and maternal mortality are also increased. Fetal/neonatal outcomes that occur with increased frequency in those of advanced age include fetal chromosomal abnormalities and some congenital anomalies; a substantial proportion of infants born to people of AMA have low birth weight (LBW) or are preterm. There is also an increased risk of perinatal mortality. #obgyn #mfm #age35 #age40 #advancedmaternalage #pregnancyover40 #pregnancyover35

Those for years have been imprinted on me in so many ways. Mostly good, but far too many bad 🥹 #obgyn #mfm #surgeon #obgyndoctor #obgynresidency #obgynresident

They all resort to the same sad tactics when they know they can’t come for me. Just know that I AINT SCURRED! People deserve the truth✌️ Benefit over profit ALWAYS! #evidencebasedmedicine #trollthetrolls #saydrake😁

There are so many beautiful experiences we have as high risk obstetrcians, but there are also many that are life changing and imprint upon our hearts and souls. The grief and trauma that is shared with our patients is real. #obgyn #mfm #brainchemistry #brainchemistryaltered #highriskpregnancy #maternalmorbidity #maternalmortality

Hyperemesis gravidarum has a reported incidence of approximately 0.3–3% of pregnancies. Without treatment, refractory hyperemesis gravidarum can result in dehydration, electrolyte deficiencies, and severe nutritional deficiencies, resulting in significant maternal morbidity. The overall goals of inpatient management of refractory hyperemesis gravidarum are the resumption of oral intake to an adequate level to maintain hydration and nutrition, including the ability to tolerate oral pharmacotherapy. Patients initially are stabilized with rehydration and electrolyte repletion. There are numerous pharmacotherapeutics available that can be administered intravenously to control symptoms when oral intake is not an option. However, despite maximizing typical antiemetics, there will be cases refractory to these medications, and alternative pharmacotherapeutics and nutrition-support modalities must be considered. Mirtazapine, olanzapine, corticosteroids, and gabapentin are examples of alternative pharmacotherapeutics, and enteral and parenteral nutrition are alternative therapies that can be used when oral intake is not tolerated for prolonged time periods with ongoing weight loss. In refractory cases of hyperemesis gravidarum, the risks and benefits of these alternative forms of management must be considered, along with the risks of undertreated hyperemesis gravidarum and the overall effect of hyperemesis gravidarum on patients' quality of life. #nvp #hg #hyperemesisgravidarum #nauseaandvomitingofpregnancy #morningsickness

#inclusivelanguage