This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as an endocrine disease involving faulty carbohydrate metabolism that complicates 3-5% of pregnancies. The document then discusses the pathophysiology of GDM, screening and diagnostic methods including oral glucose tolerance tests, maternal and fetal complications, and management approaches including careful antenatal supervision and control of blood sugar levels. Key goals of management are finding the optimal time and method of delivery and arranging newborn care.
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
diabetes is very common disorder in all age group i.e from infancy to secondary childhood age so intake of good healthy diet is very important for the production of insulin which is needed for body for regular activities
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Identifying women with GDM is important because appropriate therapy can decrease maternal and fetal morbidity .
Can prevent two generations from developing diabetes in the future.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...
Diabetes in pregnancy
1.
2. Contents
Introduction.
Definition and incidence.
Pathophysiology
Screening and diagnostic methods.
Maternal and fetal complications.
Management.
You should know now.
3. Diabetes mellitus is an endocrine
disease, involving faulty carbohydrate
metabolism, probably of genetic
origin.
DM complicates 3 – 5% of all
pregnancies, and is a major cause of
perinatal morbidity, mortality as well
as maternal mortality.
4. Altered carbohydrate metabolism of the mother, because
a) Placental insulinase breakdown the maternal insulin
a) Placenta releases contra insulin hormones like
- human placental lactogen
- Oestrogen & progesterone
Blunting the action of insulin
c) Increased insulin destruction by kidney
5. d)Increased Lipolysis – The mother uses fat for her caloric
needs and saves glucose for foetal needs.
e) Changes in glucose – The foetus uses preferentially
alanin and other aminoacids and deprive the mother
of a major gluconeogenic source.
6. Repeat and random urine samples taken on one or more
occasion through out pregnancy reveal glycosuria in 5 – 50%
cases.
Renal Glycosuria :
During pregnancy renal threshold is diminished due to
combined effect of increased GFR and impaired tubular
reabsorption of glucose.
Present most commonly in mid pregnancy.
Glycosuria is seen with blood sugar is much below 180mg%.
No Rx required, condition disappears after delivery.
7. A diabetic pregnancy is more prone to certain
complications like.
1) Spontaneous Abortions :
Insulin dependant women with initial glycosylated Hb
above 12% or persistent plasma glucose level more than
120mg/100ml have increased risk abortion.
8. 2) Polyhydraminos :
Usually associated with a large placenta and macrosomia.
Might be due to foetal polyuria due to fetal
hyperglycimia.
3) Pre-eclamptic toxaemia & hypertension :
10 – 20% of pregnant diabetic women have toxaemia or
hypertension
Incidence of increased preterm delivery, and increased
perinatal morbidity and mortality.
(As high as 20%)
9. 4) Infections :
Urinary tract infection and monilial vulvovaginitis more
likely to occur
Also high incidence of chorioaminitis, endometriosis.
(Mostly in poorly glycaemia controlled diabetic patients)
10. CAUSE : Over distended uterus due to
Associated polyhydraminos or
Macrosomic baby
Infection
Associated PIH
Increased operative delivery
CAESAREAN SECTION :
Elective CS rate higher due to increased perinatal loss after 38 wks
of gestation.
KETOACIDOSIS :
Affects only 1% of diabetic pregnancies, but it is one of the most
serious complications.
Foetal loss can be as high as 20%.
11. Pregnancy imposes a heavy burden on diabetic
patient.
More insulin is necessary to achieve metabolic
control.
Progression of diabetic retinopathy.
Worsening of diabetic nephropathy.
Increased risk of death for patients with diabetic
cardiomyopathy.
12. CENTRAL NERVOUS SYSTEM :
Anencephally
Holoprosencephally
Encephalocele
HEART AND GREATVESSELS :
Transposition of the great vessels
Ventricular septal defect
Aortic coarctation
Atrial septal defect
SKELETAL AND SPINAL :
Caudal regression syndrome
GENITOURINARY :
Renal Agencies
Ureteral duplication
GASTRO-INTESTINAL :
Oesophagial atresia
Anal atresia
13. RDS :
Neonates of the diabetic have delayed lung maturity, so
increased risk of RDS.
FETAL DEATHS :
placental insufficiency, abruption, foetal growth restriction or
oligo hydramnios present.
Hypothesis proven with foetal blood sampling by decreased
foetal pH and increased foetal PCO2.
Macrosomia :
Macrosomia – Diff. Delivery – shoulder dystocia
14. HYPERBILIRUBINAEMIA :
Pathogenesis might be due to prematurity and polycythaemia with
haemolysis.
HYPOGLYCEMIA :
Hypoglycemia of < 30mg% leads to hypotonia, hypothermia,
apnoea, convulsion.
Hypocalcaemia – seen in 50% of infants.
Predisposition to diabetes – IDM have a 1 – 3%, risk of developing
insulin dependant diabetes.
If only father – 6%, If both parents – 20%.
15. • Obesity (>200 lbs or > 15% of non-pregnant
ideal body wt.)
• Positive family history of diabetes (Sibling or
parent)
• History of still birth.
• History of delivery of a large infant
• Glycosuria
• History of unexplained neonatal death
• History of congenital anomaly
• History of prematurity
16. Screening for diabetes during Pregnancy :
Best screening test is the measurement of plasma
glucose 1 hr after ingesting 50mg of glucose (GCT)
140 mg/dl screening positive for GDM
Confirmatory test done by 3 hours OGTT.
17. Time Whole blood Mg
%
Fasting 95
1 hr 180
2 hr 155
3 hr 140
If any 2 or more values elevated GTT is abnormal.
18. Class Age of
onset
Duration (yrs) Vascular
disease
Therapy
A
- A1
- A2
Gestational
Gestational
FBS
< 105mg%
> 105mg%
2 hr PPG
< 120mg%
> 120mg%
Diet
Insulin
B Over 20 < 20 None Insulin
C 10 –19 10-19 None Insulin
D Before 10 > 20 Benign
Retinopathy
Insulin
F Any Any Nephropathy Insulin
G Any Any Proliferative
Retinopathy
Insulin
H Any Any Arteriosclerotic
heart disease
Insulin
19. PRE-CONCEPTIONAL COUNSELLING :
Joint consultation of endocrinologist, obstetrician,
dieticians
Blood glucose, HbA1c, RFT, ophthalmoscopy done
OHA changed to insulin.
PRINCIPLES OF MANGEMENT :
Careful antenatal supervision and control of diabetes
To find optimum time and method of delivery
Arrangement for care of newborn.
20.
21. ANC at monthly intervals upto 20 weeks – 2 wks interval
upto 30 wks.
Daily calorie requirement 30-35Kcal/kg body wt. + 200
Kcal.
Diet – CHO-50%, Protein-20%, Fat 25-30%.
4 meal regimen – Breakfast 25% of total calorie intake
Lunch 30%
Dinner 30%
Bed time snack 15%
Frequent blood sugar estimation
Glycosylated Hb estimation, at end of 1st
trimester and 2
monthly thereafter.
22. Sonographic evaluation to exclude cong.
Anomalies, macrosomia and IUGR (Rare)
Assessment of fetal well being is to be
made from 32 wks onwards.
When abnormal CTG, biophysical profile
done.
Doppler umbilical artery velocimetry useful
in vasculopathy
23. For glycemic goals – A double mixed regime employed.
3 – 4 daily inj. of a regular (Human Actrapid) and
intermediate acting insulin (Isophane) before dinner.
Guard for hypoglycemia for tight control of sugar.
oral antidiabetic drugs- Controversial.
ADMISSION :
Early hospitalisation facilities
Stabilisation of diabetes, minimise incidence of pre-
eclampsia, polyhydramnios and preterm labour and to
select out the appropriate time of termination of
pregnancy.
24. Stable insulin dependant pregnant diabetic can reach
term but not beyond EDD.
Unstable insulin dependant diabetes, should deliver
soon, after foetal lung maturity assessed.
To prevent intra uterine deaths in last 2 wks patient
should be admitted after 37 wks.
.
25. To control diabetes by hrly estimation of blood
glucose and split up dose of soluble insulin if
required.
To control ketosis
To maintain potassium level
Foetal monitoring like constant watch on foetal
condition.
26. Prophylactic antibiotics to minimise infection.
Insulin requirement dramatically falls following
delivery due to low levels of insulin
antagonising hormones.
Post partum assessment of carbohydrate
metabolism.
Rpt GTT after 6 wks.
27. Things you should know
Screening and diagnostic tests for diabetes in
pregnancy.
Effect of diabetes on pregnancy an fetus
Effect of pregnancy on diabetes.
Risk factors.
Antepartum surveillance.
Mx during labour.