Gestational Diabetes Mellitus: Update on Screening, Diagnosis, and Management.

Gestational diabetes mellitus (GDM) is a common condition of pregnancy with increasing prevalence in the United States. GDM increases risks of complications, including operative delivery, hypertensive disorders, shoulder dystocia, fetal macrosomia, large-for-gestational-age infants, neonatal hypoglycemia, and neonatal respiratory distress. In patients who are overweight or obese, prepregnancy weight loss and lifestyle modifications during pregnancy may prevent GDM. First-trimester screening can identify preexisting diabetes and early-onset GDM for prompt implementation of glucose control measures. Treatment of GDM has been shown to reduce the risk of complications and should start with lifestyle modifications. For patients who are unable to maintain euglycemia with lifestyle modifications alone, insulin is the recommended first-line medication. For patients with poor glucose control or who require medications, fetal surveillance is suggested starting at 32 weeks of gestation. For all patients with GDM, physicians should assess for fetal macrosomia (estimated fetal weight more than 4,000 g) and discuss the risks and benefits of prelabor cesarean delivery if the estimated fetal weight is more than 4,500 g. Delivery during the 39th week of gestation may provide the best balance of maternal and fetal outcomes. The recommended delivery range for patients controlling their glucose levels with lifestyle modifications alone is 39/0 to 40/6 weeks of gestation, and the ideal range for those controlling glucose levels with medications is 39/0 to 39/6 weeks of gestation. Practice patterns vary, but evidence suggests that glucose management during labor can safely include decreased glucose testing and sliding-scale dosing of insulin as an alternative to a continuous intravenous drip. Insulin resistance typically resolves after delivery; however, patients with GDM have an increased risk of developing overt diabetes. Continued lifestyle modifications, breastfeeding, and use of metformin can reduce this risk.

A Rare Presentation of a Morel-Lavallee Lesion of the Lower Leg Successfully Treated With Ultrasound-Guided Aspiration.

A Morel-Lavallee lesion (MLL) is a relatively rare condition that is caused by a traumatic shearing force. This force leads to a closed degloving injury of the subcutaneous tissue and fascia that creates a potential space that can fill with lymph, blood, and necrotic fat. The MLLs are traditionally seen after high impact trauma and typically located at the greater trochanter and pelvis, although recent reports have found them to be located at the knee, thigh, and lower leg. The MLLs typically present as swelling at the site of injury, which can be difficult to differentiate from several other diagnoses. This case report discusses an MLL in the lower extremity that occurred during a rugby game. A lack of familiarity with MLLs often leads to delayed diagnosis and treatment. The diagnosis was eventually made with an magnetic resonance imaging, and the lesion was successfully treated with ultrasound-guided aspiration and compression. The athlete was able to return to play without recurrence of the lesion.