Weekly ultrasounds for gestational diabetes?

Kate CP - posted on 12/22/2010 ( 28 moms have responded )

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Doctor said I need weekly ultrasounds because of my gestational diabetes. I BARELY failed the glucose test (I went over by 10 points at the 2 hour mark and 8 points at the 4 hour mark) and I'm being super strict with my diet now. I can't help but feel this is a little excessive. Thoughts? Experience?

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I can pass on something my midwife taught me and something that I plan to pass on in my own practice in the future. The B.R.A.I.N. questioning process in decision making regarding treatment/intervention options.



B:enefits. what are the benefits of the treatment/intervention being proposed? (in your case, early detection and intervention if something is affecting your baby such as abnormal development or growth, amniotic fluid levels, placental development etc; possibility of reducing other more invasive or risky [for you] procedures such as regular fingerprick BGL's etc)



R:isks. what are the risks of the proposed treatment/intervention, including not just physical risks but potential negative effects to mental health, financial or social circumstances. (in your case, no known risk of harm to mother or baby from regular ultrasounds, but also an area still undergoing research; out of pocket costs of extra ultrasounds if deemed not medically necessary; emotional, physical and mental toll if you feel these procedures are excessive or invasive etc)



A:lternatives. what are the alternatives available? (in your case, is it possible to negotiate two-weekly ultrasounds instead until/unless something changes to indicate a need for more regular ultrasounds, or increase your ante-natal visits to weekly and monitor baby and your health through less invasive/disruptive ways such as urinalysis, fundal height measurements, heartrate doppler, blood pressure etc, can you be referred to a perinatal endocrinologist, can you get a second opinion etc)



I:ntuition. what is your intuition telling you about the situation? (in your case, do you feel it is excessive and unnessecary, do you feel it is invasive or disruptive to you or baby, do you feel capable of managing your health and condition through diet etc, do you feel confident of your baby's health and your own health without this increased monitoring, do you implicitly trust your doctor that they are making the right/best decision and that they are doing so in consultation with you etc)



N:othing. what will happen if you (and the doctors) do nothing (potential risks/outcomes)? (in your case, what are the risks of doing nothing, even if only for a couple of weeks, what information can your doctor give you on the progression of your condition at this stage of your pregnancy, how will you feel emotionally and mentally if you do nothing, will you stress and worry about what could be happening, about if you have made the right decision etc)



Hope these help you in consulting with your doctor to reach the best possible treatment option decision for you. They really helped me. I have no personal experience with GD but was diagnosed in this pregnancy with a placental abnormality, a possible chorioangioma (benign tumour of abnormal bloodvessels in the placenta). It was recommended that I undergo two-weekly ultrasounds from 30 weeks to assess impact on baby's development and growth, impact on placental and umbilical bloodflow, growth and position of chorioangioma etc. I did my own research on the condition, discussed it with other professional and got a second opinion. I felt that it was invasive and excessive and in accordance with what we had already learned from earlier ultrasounds it seemed that it was unnecessary as there was so far no impact on baby and my health, no growth in size or change of position in chorioangioma. Using the above mentioned questioning process, I negotiated with my doctor to have four-weekly scans and more regular ante-natal care until/unless something changed to indicate more regular scans. You deserve to be consulted with and involved in all decisions made regarding your treatment. If you are adequately and relevantly educated and informed you deserve to have a say in how your pregnancy is managed. Let your doctor know if you feel overly stressed or concerned by their decisions and let them know they need to be prepared to negotiate with you within reason. Best of wishes to you and your family.

Mary - posted on 12/22/2010

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Here!

Unless there are other mitigating circumstances, a weekly ultrasound does seem excessive, particularly this early on. It's not something I've seen done with our gestational diabetics, especially those who are diet controlled and not requiring meds.

The only possible rationale I can come up with is that they are doing this because they have opted to not do the 4x/day fingersticks to monitor your blood sugars because of your immune disorder.

Any chance of him sending you for a consult with a perinatologist? They are (usually) best at managing diabetes in pregnancy. They wouldn't manage your entire pregnancy, nor deliver you. They would just manage your diabetes and any necessary diagnostics. I don't think it is essential in your situation, but it could be helpful.

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I know exactly what you mean about him looking for something wrong. The first obstetrician I saw was exactly like that, she would go through all the risks and worse case scenarios of my condition and instil all this fear in me, then we would do an ultrasound and everything would be fine, but then she'd schedule another ultrasound and say things like, "well, your amniotic fluid looks like it could be getting low, we'll do another ultrasound next week just to check. If your fluid gets low, it's a sign your placenta is winding up its life and we may need to induce early" which would freak me out. Eventually I got tired of her fear tactics and after another few ultrasounds where everything was okay, I just put my foot down and said no more! I had a second opinion from a specialist OB who said my fluid levels were absolutely within normal range and with my condition and at my stage of pregnancy in fact the risk (for me and baby) was actually polyhydramnios (excess fluid).

But, that is the thing with doctors and obstetricians... they are usually wonderful diagnosticians and incredibly well trained in their fields, but they do tend to view birth from a medicalised perspective. Sometimes I think they can forget that they are dealing with a human, an expectant mother that has her own fears and anxieties about her baby and birth rather than just a condition. It can be up to us to remind them that we are human beings with our baby's wellbeing and our own wellbeing as our foremost concern for 9 months as well as our own expectations, hopes and needs in developing treatment plans.

~♥Little Miss - posted on 12/22/2010

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All of the reasons will sound good when they are scaring the crap out of you. Damn....obviously you have a more complicated case than just a normal pregnancy. How would you feel about just up and going on your own for a second opinion? Would your insurance cover that? Do you have mid-wives where you are? My mid-wife was alot more informative and helpful than my original Dr. The place that I went had 5 mid-wifes and 1 Dr that they consulted with. I know for sure the one I had dealt with complicated cases...just a suggestion.

Kate CP - posted on 12/22/2010

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I only have 8 weeks left in my pregnancy. They want to do one a week...how does that equal 32 ultrasounds?

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Ez - posted on 12/23/2010

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Geez you've got a good memory Mary lol.

I agree with keeping the details and decision-making to yourself. Reassure them, but otherwise tell them it's not open for discussion!

Mary - posted on 12/23/2010

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Kate, I would advise not discussing any unnecessary details with you MIL or anyone other than your hubby...that way, they cannot give you shit, nor can they make it harder for you to stand your ground.

At 32 weeks, with your sugars controlled, and your measurements appropriate, I see no reason for you to have another US before 36 weeks. I should note, I don't know the details of your immune disorder nor how that can impact pregnancy. This is why I really think a consult with a perinatologist is your best bet. It does not involve switching doctors, but gives you more information with which to arm yourself.

I understand your fears, but put off worrying about the induction bit for a few weeks. It's not a fight you need to have yet, if at all. From what I can recall, although your labor with Sam was long, you didn't have trouble pushing her out (if you can't remember how long you pushed, then it wasn't unreasonably difficult!). This reassures me that even if this baby is a pound or so bigger, you will be just fine =)

Ez - posted on 12/23/2010

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Fiona, if I ever have another baby, can you be my midwife? ;)

Kate, I'm sorry you're feeling pressured. I have no personal experience with GD, but I would say a second opinion is worthwhile. You are clearly uncomfortable with the way things are going, and you shouldn't ever feel bullied or manipulated. Like Fiona said, sometimes we need to be our own advocates :)

Kate CP - posted on 12/22/2010

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I guess what I'm really afraid of is that he's almost LOOKING for something wrong. Something about this whole thing just makes me really, really nervous. I'm terrified he's going to want to induce me early and I'll end up with a c-section which, quite honestly, could kill me.

Kate CP - posted on 12/22/2010

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I called my insurance company and they said all the scans would be covered as long as they are medically necessary.

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Experience. That sounds stupid and in the long run very expensive. I was scanned ever 4 weeks and thats only because when they were measuring i was apparently on the bigger side. They thought at 38 weeks he was measuring 8-9pound but he was born a very healthy 7p11.
I was on insulin and was seeing a specialist for it and even then i only had 6 scans. I found out about the diabetes at 9 weeks. Very early and they thought it was permanent but lucky at the 6 week check everything was very very normal.

Sara - posted on 12/22/2010

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I felt like my doctor did a lot of CYA shit too. But, I do think it is medically indicated to induce women with GD a week or two before the due date because of the effects of the GD on the placenta. I'm not medical professional, but I tried to educate myself as much as I could when I had GD.

Kate CP - posted on 12/22/2010

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*sigh* Now my MIL is giving me a hard time for not taking my doctor's expert opinion.

Krista - posted on 12/22/2010

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I had an ultrasound every week for the last 6 weeks, if I recall correctly. It's basically to make sure that the baby isn't macrosomic, but really, the accuracy wasn't all that shit-hot anyway. He figured the baby was between 8 and 9 lbs, and he was only 7lbs 11 oz.

I like Mary's advice (well, I always like Mary's advice when it comes to these things, so that's a given.)

Kate CP - posted on 12/22/2010

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He's doing it just to cover his ass. I'm really stubborn so he'll have to really convince me that my son's life is in jeopardy before I tell him he can induce me. And then only IF my cervix is ready for it. I am *N O T* letting them give me a c-section unless he or I is about to die. It's NOT going to happen.

~♥Little Miss - posted on 12/22/2010

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Mary, are there any other ways to check fluid level? You might be SOL Kate. I am sorry, If this is the only way, don't let all these ultrasounds don't stress you out to much and effect your health more. I truly wish the best for you and your baby. I hope there is another way for the medical professional to monitor this.

Kate CP - posted on 12/22/2010

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Just talked to the good doctor again. He's worried that because I'm already high risk (because of my immune disorder) that my placenta will start to become insufficient and he wants to check the fluid levels and size of the baby.

...If he thinks I'm going to let him induce me early without a really good fuckin' reason he's out of his goddamn mind.

Sandra - posted on 12/22/2010

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I think it's a little excessive also. I had insulin-dependent gestational diabetes. For the 3 weeks before I was put on insulin, my numbers were always high and it just kept getting worse. I had NST's twice a week and two extra US's only because he was also breech. But for someone who has controlled numbers, I couldn't see why. I'd definitely ask some more questions as to his reasoning for the US's.

~♥Little Miss - posted on 12/22/2010

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AHHHHH!!!!!!!! LOL....I don't know why I did months instead of weeks....

Morgan - posted on 12/22/2010

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I had the same I had 23 ultra sounds in the last 4 months of my pregnancy, they probaly just want to monitor babys weight

~♥Little Miss - posted on 12/22/2010

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Hmmmm. That is ALOT of ultrasounds. If they have not already recommended a perinatologist like Mary recommended, they I would be asking for a reference ASAP! With both of my children I had 5 ultrasounds and I felt THAT was excessive! Man...or just ask them for the finger sticks. Thats up to 32 more ultrasounds!

Laura - posted on 12/22/2010

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I have GD too (failed big time), am at 32 weeks right now. I had my second ultra sound 2 weeks ago (measuring a little big) and have one next Tuesday. Seeing my OB every 2 weeks and calling in blood sugars every week. I don't know what I'm going to have to do after next week but it seems that once a week is a little much unless you were measuring way ahead. But this is the first time I've had GD so I really don't know Standard procedure. Good luck to you

Kate CP - posted on 12/22/2010

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I did. He says he just wants to make sure the baby's developing okay and not getting too big. But he says I'm not measuring large. My urine is fine (no ketones, no glucose, no protein), my blood pressure is fine...I really don't know how I feel about this.

Sara - posted on 12/22/2010

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yeah, that seems like overkill to me...i'd ask some more questions about why he thinks they're necessary.

Kate CP - posted on 12/22/2010

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Well, I'm 32-33 weeks now...I was seeing him every 2 weeks but weekly ultrasounds until I deliver makes me nervous.

Sara - posted on 12/22/2010

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I think it's excessive. I had several during my pregnancy when I had GD, but not until the end and it was to try and gauge how big the baby was getting. I think during the course of my pregnancy I had maybe 5 ultrasounds.

I did, however, have to have weekly non-stress tests.

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