Incidence of Diabetes in pregnancy ( GDM or Pre existing ) 5% Of the women with DM in Pregnancy GDM is 87% Greater maternal and fetal morbidity if poor controlled

1. CURRENT MANAGEMENT OF
GESTATIONAL DIABETES
DR BUSHRA SAEED ST4
DR SINGHARATHNAM REGISTRAR
DR NAZIA NAFEES SENIOR HOUSE OFFICER
MR P DONKOR CONSULTANT OBSTETRICS AND GYNAECOLOGY
OBSTETRICS AND GYNAECOLOGY DEPARTMENT
PRINCESS ALEXANDRA HOSPITAL
HARLOW, ESSEX, UNITED KINGDOM

2. INTRODUCTION
Diagnose gestational diabetes if the woman has either:
a) Fasting plasma glucose level of 5.6 mmol/litre or above
OR
b) 2-hour plasma glucose level of 7.8 mmol/litre or above

3. GESTATIONAL DIABETES
• Incidence of Diabetes in pregnancy ( GDM or Pre existing ) 5%
• Of the women with DM in Pregnancy GDM is 87%
• Greater maternal and fetal morbidity if poor controlled

4. STATISTICS AT PAH : JANUARY TO DECEMBER
2016
• Total no of deliveries 4100
• No of patients with ,
• GDM 130 pts Type 1DM 20 pts Type 2 DM 14pts
• No of patient audited : 40

5. OBJECTIVES
• Maintaining standard care as per NICE and local guidelines

6. METHODS
• Retrospective audit
• Cases identified using clinical coding
• Electronic record and patient notes reviewed
• Result analysed

7. RESULTS
• Age of patient range : 25 to 39
Mean Age : 32
• BMI Range : 18 to 47
Mean : 28

8. RESULTS
• Parity : P0. 37.5%
P1. 45%
P2. 12.5%
P3. 2.5%
P4. 2.5%
0
2
4
6
8
10
12
14
16
18
P0 P1 P2 P3 P4
Parity

9. RESULTS
• Ethicnicity:
• British/White Caucasian : 45% Not documented : 10%
• European ( Irish , South , North ) : 17.5%
• Asian : 17.5%
• African : 10%

10. RESULTS : RISK FACTORS AT BOOKING
• Previous GDM 22.5% High BMI. 22.5%
• Family Hx of GDM. 35% Ethnicity. 5%
• Previous Big Baby. 2.5% No risk at booking. 15%
• Not documented. 2.5%

11. RESULTS : RISK FACTORS AT BOOKING
• PCOS
• Rheumatoid artheritis , off steroid
• Medication: Haloperidol
• Some patient have more than 1 risk factors at booking

12. RESULTS :
• Pt with risk factors at booking : 82.5%
• No risk factors : 15%
• Not documented 2.5%
risk present no risk not documented
82.5%
15 %

13. RESULTS
• Gestation at diagnosis :
• Range : 7 to 34 weeks
• Mean. 20 week

14. RESULTS
• HbA1c was performed for 67.5% pts OGTT in 95% pts
• Glycosuria was present only in 5% pts. HBGM in 90% pts (4 no
orange notes)
• Ultrasound Findings:
• Macrosomia in 22.5% pts SGA in 2.5% pt
• Polyhydrominos in 5% pts Bilateral Talipes in 2.5% pt
• Pelvic Fetal Kidney in 2.5% pt

15. RESULTS
• Management :
Diet control : 32.5%
Metformin : 40%
Insulin : 7.5%
Metformin + Insulin : 20%
Treatment
Diet Metformin Insulin Met + Insulin
Diet
Both
Insulin
Metformi
n

16. RESULTS
• Gestation at onset of labour
• Range : 37 to 40 weeks
Onset of Labour
Spontaneous. 32.5%
IOL. 57.5%
ELCS. 10% ( for previous CS/Breech)
Onset of Labour
IOL Spontaneous ELCS
IOL
Spontaneous
ELCS

17. RESULTS
• Reasons for IOL
• Poor control GDM 2.5%pt
• PROM 5% pt
• AC > 95th centile 7.5% pts
• GDM ( Majority at 40 week)

18. RESULTS
• Mode of Delivery:
• NVD. 60%
• Instrumental delivery. 15%
• EMCS. 10%
• ELCS. 15%
0
5
10
15
20
25
NVD ELCS EMCS Instrumental Del
Chart Title

19. RESULTS
• Maternal Complication ;
• 2nd degree tear. 30%pts
• 3B tear. 2.5% pt
• Episiotomy 5% pts
• MROP 2.5% pt
• PPH. 5% pts
• No Complication 27.5% 0
2
4
6
8
10
12
14
2nd Degree Tear 3 B tear Episiotomy MROP PPH No Complication
Maternal Complications

20. RESULTS
• Baby weight :
• Range : 2074g To 5475g
• Neonatal Readmission : None
• Hypoglycemia . 7.5% Shoulder dystocia x None NICU
admissions. 7.5%
• Any other complication :
• 2.5% x congenital pneumonia. 2.5% x jaundice

21. RESULTS
• APGAR :
• At 1 min : 9 in 55% pts
• At 5 min : 8 in 10% pts
9 in 55% pts
10 in 35% pts

22. RECOMMENDATIONS
• Re audit to close the audit loop