Which of the following should be the line of management in a pregnant female with controlled diabetes?
Ans. b (Pregnant females with controlled diabetes are more likely to deliver child by normal vaginal delivery without any complication). (Ref. Dutta, Obstertics, 6th ed., p 284)DIABETES IN PREGNANCY# Gestational diabetes usually begins in the second half of pregnancy, and goes away after the baby is bom.Effects on the fetus:# Macrosomia# IUGR# Newborns of diabetic mothers are at risk of hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia, and hyperviscosity.# Caudal regression syndrome: sacral agenesis (most characteristic feature)# Congenital defects: In pregnancies complicated by type I or II diabetes, the major cause of neonatal mortality is congenital malformation incompatible with life. Therefore, MS AFP should be determined at 16 to 18 wk gestation, and a thorough ultrasound examination should be performed at 18 to 22 wk.# Respiratory distress syndrome# Left lazy colon syndrome# Stillbirth or death as a newborn is rare.# Increased risk of the baby developing type II diabetes or being overweight later in life.Effects on the mother# Women who get gestational diabetes are more likely to develop gestational diabetes in future pregnancies, and are at a higher risk of developing type II diabetes later in life.# Diagnosing gestational diabetes- Urine is routinely tested for sugar throughout pregnancy, and high blood sugar, if present, is usually detected between 24 and 28 weeks of pregnancy.- The only way to confirm gestational diabetes is with a glucose tolerance test, which needs to be carried out after eight hours without food.- When suspected, GTT may be carried out earlier than 24-28 weeks.Q# Treatment- A few women's blood sugar levels remain too high, and they may need daily injections of insulin.- The extra insulin will not cross the placenta and will not affect the baby.- In almost every case, gestational diabetes disappears on its own after delivery.Q# Labor and Delivery- During the 3rd trimester, care of diabetic women consists mainly of controlling maternal plasma glucose levels, assessing fetal well-being, and determining fetal pulmonary maturation.- For most women with gestational diabetes, labor begins spontaneously at term, and delivery is vaginal. If these pregnancies go beyond 42 wk, the fetus is at risk of death in utero, so labor should be induced.- Cesarean section may be necessary in cases of dysfunctional labor or cephalopelvic disproportion or to avoid shoulder dystocia and injury to the newborn and to the birth canal.# Postpartum Care- For women with type I diabetes, insulin requirements decrease dramatically but gradually increase after about 72 h.- Women who have had gestational diabetes should have a 2-h oral glucose tolerance test with 75 g of glucose at 6 to 12 wk postpartum to determine whether they are normal, clearly diabetic, or have impaired glucose tolerance (based on WHO criteria).Educational points:HPL has putative actions in a number of important metabolic processes. These include.1. Maternal lipolysis and an increase in the levels of circulating free fatty acids, thereby providing a source of energy for maternal metabolism and fetal nutrition.2. An anti-insulin or "diabetogenic" action, leading to an increase in maternal levels of insulin, which favors protein synthesis and provides a readily available source of amino acids for transport to the fetus.3. A potent angiogenic hormone; it also may play an important role in the formation of fetal vasculature.
Even controlled diabetes in pregnancy does not disappear on its own and needs extensive treatment even after delivery
Pregnant females with controlled diabetes are more likely to deliver child by normal vaginal delivery without any complication.
In all females with gestational diabetes, blood sugar levels remain too high, and daily insulin therapy is essential.
LSCS is must in almost every case of gestational diabetes
Miscellaneous (Gynae)