A case of Overt DM in pregnancy

1. CASE PRESENTATION ON GDM
-Dr Khush (JR2)

2. Introduction:
Name: Namrata Rohit
Age: 27 yrs
Date of admission: 28/12/23
Resident of: Kharghar

3. PRESENTING COMPLAINTS:
27 yr/F ms 2 yrs Primigravida 38+0 wk BD and 38+0
wk BS (13+1) with overt diabetes mellitus came for
routine ANC checkup.

4. HISTORY OF PRESENT PREGNANCY
• Patient is known case of Diabetes mellitus before pregnancy and was on Diabetic diet.
• Earlier patient was on T. Glycomet 500 mg TD since 2nd Month of Pregnancy.
• Folic acid taken.
• H/o White discharge per vagina in November 2023. Clingen vaginal pessary taken for 7 days.
• H/o itching over lower abdomen in Nov 2023. Patient Diagnosised as Polymorphic eruption of
Pregnancy. Patient treated with: T. Loratidine and Calosoft lotion.
• H/o Previous hospitalized ivo HGT charting on 18th and 19th Dec 2023. Treated medically during
which patient was shifted to T. Glycomet 500 mg BD.
• No history of excessive vomiting, fever or rashes.
• No history of polyuria, polyphagia, polydypsia or burning micturition.
• No history of pain in abdomen, bleeding per vagina, leaking per vagina or decrease in fetal
movement.
• ANC registered
• Iron, Calcium and Protein powder taken.
• Immunized.
• Family history: Patients mother is kco DM since 7 years.

5. MENSTRUAL AND OBSTETRIC HISTORY
MC - 4-5 days / 30 days
Moderate, painless and regular.
LMP - 6/4/23
EDD - 11/1/24
UDD - 11/1/24 (13+1)
O/H - Primigravida

6. 1. 10/05/23: TSH = 2.85, GCT = 92 mg/dL
2. 03/10/23: RBS = 79.4, HbA1c = 5.4%
3. 27/11/23: FBS - 65, PPBS - 112, LFT WNL
4. 19/12/23: FBS - 98, PPBS - 105, Creat =0.51
5. 28/12/23: HHH - NR, Urine R/M WNL
6. 29/12/23: FBS - 84, PPBS - 117, HbA1c - 6.2%
7. 30/12/23: Lipid profile:
• LDL = 55.2 (60-100)
• TG = 209 (40-160)
• VLDL = 41.8 (7-35)
• Rest WNL
8. 31/12/23: FBS - 74, PPBS - 82
LABORATORY INVESTIGATIONS
CBC 27/11 28/11 1/12
Hb 13.0 11.8 9.7
PCV 39.0 36.3 29.1
TLC 9.8 11.11 14.96
Plat 290 255 191

7. USG Obstetric and Doppler (26/12/23)
• SLIUG - 37+2 weeks
• CA ++ (130 bpm)
• Longitudinal lie, Cephalic presentation
• Placenta - Anterior and right lateral
• AFI - 14-15 cm
• EFW = 3229 g.
• Doppler = Normal
NT scan = 1.1 mm (7/7/23)
Anomaly scan = WNL (2/9/23)
RADIOLOGICAL INVESTIGATIONS

8. EXAMINATION ON ADMISSION
On General examination:
General condition - Fair
Temperature - Afebrile
Pallor absent
edema absent
clubbing absent
icterus absent
cyanosis absent
Lymphadenopathy absent
P - 90 bpm
BP - 120/90 mmhg
On Systemic Examination:
Cardiovascular system - S1 and S2 heard. No murmur heard.
Respiratory system - Normal vesicular breath sounds heard. No added
sound heard.
Central nervous system - Patient well oriented in time, place, person.
No focal neurological deficit.
Ophthalmologic examination - No findings of diabetic retinopathy or
any other abnormality noted.

9. Obstetric examination:-
Inspection:
Abdomen is uniformly distended and has an ovoid shape.
Corresponding quadrants move equally with respiration.
Umbilicus is everted
Striae gravidarum, linea nigra seen
No scars, dilated veins over the abdomen
Palpation:-
Fundal height corresponds to term pregnancy
Uterus is relaxed

10. Leopold first grip/Fundal grip :
soft, irregular, broad and not independently
ballotable mass at fundus
INFERENCE: Breech of fetus is at fundus of
uterus
Leopold-sporelein’s second grip/Lateral
grip :
Right – knob like structures suggestive of
limbs Left – uniform continuous curved
resistance suggestive of spine
INFERENCE:
1. LIE= Longitudinal lie
2. Position = left occipitoanterior
3. Fetal movements well perceived=fetus
viable
Leopold-sporelein’s third /PAWLIK’s/
1st pelvic grip :
smooth, hard, globular,independently
ballotable mass, suggestive of head
INFERENCE:
1.Engagement=not engaged
2.Attitude= well flexed with thumb at
higher position palpating sinciput
Leopold-sporelein’s 4th grip/2nd pelvic
grip :
fingers converge, head not engaged

11. AUSCULTATION
Foetal heart sounds heard along spino-umbilical line
Foetal heart rate : 140 beats/min, regular rhythm
NST:
Baseline - 144 bpm
Acceleration - 2
Deceleration - 0
BTBV - Good
Reactive NST

12. MEDICATIONS DURING COURSE OF STAY
• Injectables: (3 days)
1. Monocef 1g
2. Metro 100cc
3. Pan 40mg
4. Emset 4mg
5. Tranexa in 100cc NS
6. PCM in 100cc NS
• Oral: (5 days)
1. T Monocef 200 mg BD
2. T Metro 400 mg TDS
3. T Pan 40 mg OD
4. T AtoZ OD
5. T Limcee BD
6. T Shelcal BD
7. C Autrin OD
8. T Metformin 500 BD
Patient’s DFKC and HGT charting were maintained daily

13. PROVISIONAL DIAGNOSIS:
27 Y/F M/S 2 Yrs, Primigravida, 38 wks BD and BS
(13+1 wks) with Overt Diabetes Mellitus

14. SURGERY DETAILS:
Surgery - Emergency LSCS ivo high floating head with
Inlet CPD with Overt Diabetes mellitus
Done on - 30/12/23.
Birth time - 12:25 AM
Sex of baby - Male
Birth Weight - 2775 grams
Baby cried immediately after birth
Apgar score = 8-9-9.

15. REFERENCES:
• Med ref ivo HGT management (18/12/23)
Advice:
S/T - FBS, PPBS, Lipid profile, S. Creatinine
Hgt charting TDS
T. Metformin 500 mg BD
Diet ref and Ophthal ref
• Med ref done ivo Sugar controls in Post operative
period (30/12/23)
Advice:
Continue T. Metformin 500 mg BD po
Send FBS, PPBS, Lipid profile
• Med ref done ivo above mentioned test results:
Advice: w/h T. Metformin 500 mg.
Follow up with FBS and PPBS after 2 weeks.
• Diet ref(29/12/23) adviced:
Diabetic diet
• Ophthal ref(29/12/23) adviced:
No evidence of any findings of
diabetic retinopathy or any
other abnormality