Case presentation for Gestational Diabetes Mellitus. For medical students.

1. DR. BARUN RAI
General Gynaecology & Obstetrics
PHASE ‘B’ Resident.
BSMMU

2. Mrs. Nasima, 36yrs old housewife of a middle class family,
Para: 1(Home delivery), from Mohakali was admitted in
BSMMU on 25/09/2018 at 36 weeks & 4 days of pregnancy
with complain of :
 Less fetal movement.
 Known case of Hypothyroidism & Diabetes in pregnancy.

3. According to patient’s statement she was a regularly
menstruating woman with average flow and duration. Her
LMP was on 12/01/2018 and accordingly EDD would be
on 19/10/2018 which corresponds with her early USG. It
is her first issue since her second marriage . She was not
on regular antenatal check up was duly immunized
against tetanus.

4. Her first pregnancy was 19 years ago ( first marriage ), a male
baby was born at home ( 1999). She remarried in the year 2011.
Couple did not practice any contraceptive method till date.
She was diagnosed as hypothyroid 4 years back ( 2014 ) and
has been under medication ( Tab. Thyrox 50mg), ever since. Her
pregnancy was uneventful upto 35 weeks of gestation then her
fasting blood sugar level & 2 hours after 75gms of glucose was
found to be increased. 6.6mmol/l & 11.1mmol/l respectively.
(15/09/18). She was then advised to control blood glucose by
diet.

5. From then on her blood glucose was controlled with the diet
and her blood glucose was monitored regularly.
 Her bowel and bladder habit is normal. She gives no history
of burning sensation during micturation, excessive per
vaginal whitish discharge or vulvo vaginitis.
 She complained of less fetal movement since 1 day then
she was admitted to BSMMU for further management.

6.  Patient is nonalcoholic, nonsmoker.
 She gives no family history of diabetes, hypertension.
 Tab. Thyrox 50mg ( 1+0+0).

7.  With due consent and maintaining adequate privacy I
examined her on 27/09/18 and found shes anxious but
cooperative. She was mildly anaemic, non icteric, non
oedematous
 Her pulse-74b/min, BP-110/70mm of Hg, temp- normal.
 Thyroid gland was not enlarged.
 No accessible lymph node was palpable.
 Breast showed normal pregnancy changes.
 Cardio-respiratory system examination revealed no
abnormality.

8. On per abdominal examination
 Abdomen was uniformly enlarged. Umbilicus centrally
placed and everted. Striae gravidarum and linea nigra
were present.
 There was no other scar mark in abdomen.
 Symphysio fundal height was 36 cm which corresponds
with gestational age, abdominal girth was 102 cm.
 There was a single fetus with longitudinal lie, cephalic
presentation. Head was not engaged.
 Liquor volume seemed to be adequate.

9.  FHR was 136 b/min.
 Per vaginal examination : not done.
So from history and clinical examination, my provisional
diagnosis is
2nd Gravida @ 36 weeks +4 days of pregnancy with
Diabetes in pregnancy ( on diet ) with hypothyroidism with
less fetal movement.