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Play a game with the speakers turned off, and you ll quickly realize how important sound is The pictures tell you what is happening, but the sound tells you how it feels and even what it means Even Pong benefited from its cheerful blip sound when you hit the ball and its sad bwonk sound when you missed it Nowadays, games can have hundreds of different effects and ambient noises, as well as a full orchestral musical score As I said earlier in this chapter, the audio engineers are the ones most likely to be organized into a separate department of their own, partly because their work is noisy

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1 Preconceptual counseling, achievement of normal hemoglobin A1c levels before pregnancy, glucose monitoring and control, diet and exercise adjustments, and insulin if necessary 2 In addition to a routine prenatal checkup, the patient should be assessed for glycosylated hemoglobin concentration; baseline renal function with serum creatine level and a 24-hour urine collection analysis; asymptomatic bacteriuria by urine culture; thyrotropin and free thyroxine; electrocardiogram; dilated and comprehensive eye examination by an

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ophthalmologist; and first trimester ultrasound examination to confirm gestational age 3 Monitoring of and intervention for fetal or obstetrical complications What antepartum fetal assessment is appropriate in women with 1 An ultrasound assessment for fetal growth and anatomy pregestational diabetes (ie, heart) and a fetal echocardiogram should be completed around 18 20 weeks 2 Testing for fetal malformations should also be performed in the first trimester (nuchal translucency and serum screening for neural tube defects and/or second trimester triple or quadruple screening) 3 At 32 weeks, a weekly nonstress test and/or biophysical profile, and amniotic fluid volume should be performed increasing to two times a week beginning at 36 weeks 4 Another ultrasound at 38 weeks of gestation to estimate fetal weight, reevaluate cardiac morphology, and assist with delivery plans It is found in 5 10% of all pregnancies complicated with pregestational diabetes mellitus It is more common in Type I pregestational diabetes mellitus The typical presentation includes abdominal pain, nausea and vomiting, altered sensorium, low arterial pH, low serum bicarbonate, serum and urine ketones, and increased anion gap Recurrent late decelerations may be seen on fetal heart monitoring (improves when maternal ketoacidosis is corrected) and are signs of fetal distress (academia) The same as in nonpregnant women Aggressive hydration and IV insulin is mandatory Glucose, potassium, and bicarbonate levels should be monitored closely and replenished

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and can distract their colleagues, and partly because they re not always needed full-time on a project

How common is diabetic ketoacidosis (DKA) in women with pregnancyrelated diabetes and what is the typical presentation

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What is parvovirus B19 What is the incidence of parvovirus B19 infection in pregnant women What is the transmission rate of parvovirus B19 from an infected woman to her fetus How is parvovirus diagnosed Describe the major manifestations of infection with parvovirus B19 A single-stranded DNA virus 3 4% Approximately 20% it is the highest if infection occurs between 10 and 20 weeks of gestation Serologic testing of IgM and IgG antibodies A self-limited infection known as erythema infectiosum or fifth disease that consists of:

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