5. GDM
Antepartum
• Fetal complication
• Maternal complications
Fetal
complication
Miscarriage
• early abortion is associated with poor
glycemic control
– HbA1c concentrations were > 12 percent
or
– persis...
Preterm Delivery
• the incidence of preterm birth was 28
percent
• a fivefold increase compared with that of
their normal ...
Fetal malformations
• related with poorly controlled diabetes during
both preconceptionally and early in pregnancy
• etiol...
Macrosomia
• infants whose birthweight exceeds 4000
g. or large-for-gestational age
• The incidence of macrosomia rises wh...
IUGR
• Diabetic mothers with vascular
complication
uteroplacental insufficiency
IUGR
• Incidence : IUGR<<macrosomia
Unexplained Fetal
Demise• Unexplained
• These infants are typically large-for-gestational
age and die before labor, usuall...
Polyhydramnios
• fetal hyperglycemia causes polyuria
• amnionic fluid index related with amnionic
fluid glucose concentrat...
Maternal
complications
Diabetic Nephropathy
• Causes end-stage renal disease in is
nearly 30 percent in
individuals with type 1 diabetes and
rang...
Diabetic Nephropathy
• nephropathy in type 1 disease begins with
microalbuminuria—30 to 300 mg/24 h of
albumin
• After ano...
Diabetic Nephropathy
• Diabetic patient with renal involvement are
at increased risk for preeclampsia
• no long-term seque...
Diabetic retinopathy
• related to duration of diabetes.
• first and most common visible lesions :
nonproliferative retinop...
Diabetic Neuropathy
• Peripheral symmetrical sensorimotor
diabetic neuropathy is
uncommon in pregnant women.
• Most common...
Diabetic Ketoacidosis
• 1-3 percent of diabetic pregnancies
• The incidence of fetal loss is about 20
percent with ketoaci...
Preeclampsia
• risk factors for preeclampsia include any
vascular complications
• Hypertension is the major complication
t...
Infections
• Almost all types of infections are
increased in diabetic pregnancies.
• 80% percent of type 1 diabetes develo...
Common infections
• include candida vulvovaginitis,
• urinary infections,
• respiratory tract infections,
• puerperal pelv...
Upcoming SlideShare
Loading in...5
×

Complication

147

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
147
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • โอกาสแท้งมักจะเจอในคนไข้ที่ poor control มี HbA1c concentrations were &gt; 12 percent or ระดับน้ำตาลก่อนอาหาร &gt; 120 mg/dL ซึ่งโอกาสแท้งจะสูงถึง 24% โดยเข้าใจว่าเกิดจากภาวะ hyperglycemia ทำให้ผิดปกติของกระบวนการ glycolysis ซึ่งเป็นส่วนที่สำคัญในกระบวนการ embryogenesis
  • Complication

    1. 1. 5. GDM
    2. 2. Antepartum • Fetal complication • Maternal complications
    3. 3. Fetal complication
    4. 4. Miscarriage • early abortion is associated with poor glycemic control – HbA1c concentrations were > 12 percent or – persistent preprandial glucose concentrations were > 120 mg/dL
    5. 5. Preterm Delivery • the incidence of preterm birth was 28 percent • a fivefold increase compared with that of their normal population • Related with poor control GDM or GDM with hypertension
    6. 6. Fetal malformations • related with poorly controlled diabetes during both preconceptionally and early in pregnancy • etiology was multifactorial • Most common : CVS ( VSD ) , Skeletal system ( Caudal regression syndrome ) , neurovascular system ( NTD ) • Diabetes is not associated with increased risk for fetal chromosomal abnormalities
    7. 7. Macrosomia • infants whose birthweight exceeds 4000 g. or large-for-gestational age • The incidence of macrosomia rises when mean maternal blood glucose concentrations > 130 mg/dL • Maternal hyperglycemia fetal hyperinsulinemia • excessive fat deposition on the shoulders and trunk, which predisposes them to shoulder dystocia or cesarean delivery
    8. 8. IUGR • Diabetic mothers with vascular complication uteroplacental insufficiency IUGR • Incidence : IUGR<<macrosomia
    9. 9. Unexplained Fetal Demise• Unexplained • These infants are typically large-for-gestational age and die before labor, usually at 35 weeks or later • hyperglycemia-mediated chronic aberrations in transport of oxygen and fetal metabolites • maternal hyperglycemia>> osmotically induced villous edema >>impaired fetal oxygen transport • increased frequency in • severe preeclampsia • vascular complications
    10. 10. Polyhydramnios • fetal hyperglycemia causes polyuria • amnionic fluid index related with amnionic fluid glucose concentration
    11. 11. Maternal complications
    12. 12. Diabetic Nephropathy • Causes end-stage renal disease in is nearly 30 percent in individuals with type 1 diabetes and ranges from 4 to 20 percent in those with type 2 diabetes. • end-stage renal failure at a mean of 6 years after dm • the incidence of nephropathy in individuals with type 1 diabetes decline with glucose control
    13. 13. Diabetic Nephropathy • nephropathy in type 1 disease begins with microalbuminuria—30 to 300 mg/24 h of albumin • After another 5 to 10 years of overt proteinuria more than 300 mg/24 hr patient may develops end-stage renal disease
    14. 14. Diabetic Nephropathy • Diabetic patient with renal involvement are at increased risk for preeclampsia • no long-term sequelae of pregnancy on diabetic nephropathy • The incidence of either micro- or macroalbuminuria was not increased in women with prior pregnancies compared with that of nulliparas
    15. 15. Diabetic retinopathy • related to duration of diabetes. • first and most common visible lesions : nonproliferative retinopathy severity preproliferative retinopathy • pregnancy worsens proliferative retinopathy • laser photocoagulation and good glycemic control during pregnancy decreases progression
    16. 16. Diabetic Neuropathy • Peripheral symmetrical sensorimotor diabetic neuropathy is uncommon in pregnant women. • Most common : diabetic gastropathy in pregnancy >> nausea and vomiting • Treatment : metoclopramide and H2- receptor antagonists
    17. 17. Diabetic Ketoacidosis • 1-3 percent of diabetic pregnancies • The incidence of fetal loss is about 20 percent with ketoacidosis • Pregnant women usually have ketoacidosis with lower blood glucose levels than when nonpregnant
    18. 18. Preeclampsia • risk factors for preeclampsia include any vascular complications • Hypertension is the major complication that most often forces preterm delivery in diabetic women. • the perinatal mortality rate is increased 20-fold for preeclamptic women with diabetes compared with that for those who remain
    19. 19. Infections • Almost all types of infections are increased in diabetic pregnancies. • 80% percent of type 1 diabetes develop at least one infection during pregnancy compared to 25 % without diabetes • wound complications after cesarean delivery x2-3 times • antepartum pyelonephritis xx 4 times
    20. 20. Common infections • include candida vulvovaginitis, • urinary infections, • respiratory tract infections, • puerperal pelvic infections
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×