This document discusses diabetes in pregnancy, including gestational diabetes and pre-existing diabetes. It defines the different types of diabetes in pregnancy and provides statistics on prevalence. Screening recommendations are outlined as well as management approaches, including maintaining good glycemic control through monitoring, medical nutrition therapy, and insulin when needed. Potential maternal and fetal/neonatal complications are described if glycemic control is not well managed.
Important core knowledge about management of diabetic female in pregnancy and what are the possible fetal and neonatal complications and risk factors.
book: Obstetrics by Ten teachers.
Gestetional hypertension, Preeclampsia and Eclampsiasunil kumar daha
Please find the power point on Gestetional hypertension, Preeclampsia and Eclampsia . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Important core knowledge about management of diabetic female in pregnancy and what are the possible fetal and neonatal complications and risk factors.
book: Obstetrics by Ten teachers.
Gestetional hypertension, Preeclampsia and Eclampsiasunil kumar daha
Please find the power point on Gestetional hypertension, Preeclampsia and Eclampsia . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
An alternative way at looking at pregnancy complicated by diabetes. A guide for the student in understanding this problem and the important points to be included in a clinical assessment.
Gestational Diabetes is a kind of diabetes that only pregnant women get.If a woman get diabetes or high blood sugar when she is pregnant, but she never had it before, then she has gestational diabetes.
Preeclampsia is a disorder that is unique to human pregnancy, and the only known cure for this complication is delivery. Preeclampsia affects approximately 4% to 5% of pregnancies . The Preeclampsia Foundation states that: “Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.” As is evident from the statement that, preeclampsia is a major contributor to maternal and fetal morbidity and mortality worldwide. In India, the incidence of preeclampsia is reported to be 8-10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with preeclampsia in 5.4% of the study population in India
An alternative way at looking at pregnancy complicated by diabetes. A guide for the student in understanding this problem and the important points to be included in a clinical assessment.
Gestational Diabetes is a kind of diabetes that only pregnant women get.If a woman get diabetes or high blood sugar when she is pregnant, but she never had it before, then she has gestational diabetes.
Preeclampsia is a disorder that is unique to human pregnancy, and the only known cure for this complication is delivery. Preeclampsia affects approximately 4% to 5% of pregnancies . The Preeclampsia Foundation states that: “Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.” As is evident from the statement that, preeclampsia is a major contributor to maternal and fetal morbidity and mortality worldwide. In India, the incidence of preeclampsia is reported to be 8-10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with preeclampsia in 5.4% of the study population in India
This talk was delivered for postgraduates and faculty of Dr. TMA Pai Hospital, Udupi on 07 March, 2017. This talk covered pathophysiology, screening, diagnosis, complications and management of diabetes mellitus in pregnancy.
Gestational diabetes mellitus (GDM) is a condition that develops during pregnancy when the body is not able to make enough insulin. GDM affects 2-10% of women during pregnancy.It is important to recognize and treat gestational diabetes as soon as possible to minimize the risk of complications to mother and baby.
Diabetes and pregnancy - Endocrine society guidelines 2013Jagjit Khosla
This presentation talks about diabetes mellitus in relation to pregnancy. It classifies diabetes in pregnant pts as overt and gestational diabetes. Then it discusses the various guidelines given by Endocrine Society in 2013 for management of diabetic patients during pregnancy
Philippine CPG on Diagnosis & Screening for Gestational DiabetesIris Thiele Isip-Tan
Philippine CPG on diagnosis and screening of gestational diabetes presented for comments at the 3rd Unite for Diabetes Annual Convention this September.
Diabetes during Pregnancy - Risk Factors, Detection, & TreatmentAshutosh Pandit
Diabetes during pregnancy can severely affect the health of both - mother & baby. Find out the symptoms and complications of Gestational Diabetes and learn how it can be detected & treated.
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A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
The Primary Care Physician's guide to management of Pregnancy DiabetesHanifullah Khan
A guide on the screening, diagnosis and management of diabetes in pregnancy aimed at facilitating the handling of this condition in a primary care setting. Includes details on medications and dosages
Definition
Incidence
Types
Diabetogenic effect of pregnancy
Metabolic changes during pregnancy
Risk of uncontrolled DM on pregnancy
Diagnosis and evaluation
Medical management
Nursing management
Definition of Diabetes mellitus:It is inability to metabolize glucose properly. It is a chronic systemic disease, manifesting metabolic and vascular changes affecting every organ in the body.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
a. Pregestational (preexisting) diabetes
Occurs when have type 1 or type 2 diabetes before becoming pregnant.
1-Type I Insulin-dependent (IDDM) (Insulin deficient).
2-Type II Non-Insulin dependent (NIDDM) (Insulin resistant).
b. Gestational diabetes mellitus (GDM).
Occurs diabetes when becoming pregnant.
Diabetes may appear only during pregnancy due to :-
1-Increased levels of antiinsulinas (estrogen, progesteron, human placental lactogen, and prolactine).
2-Decreased renal threshold for glucose (glucose loss in urine).
During early stage of pregnancy: Maternal hypoglycemia.
After the fourth month: increase glucose level in the blood due to placental hormones
During labor: liability to hypoglycaemia.
After delivery: glucose level return to prepregnant state.
Gestational Diabetes
Risk Factors
Maternal age >25
Family history
Glucosuria
Prior macrosomia
Previous unexplained stillbirth
Risk of uncontrolled diabetes on pregnancy
A- Maternal effect:
On pregnancy On labor On puerperium
-Abortion - premature -puerperal sepsis
-PET labor -PPH
-Polyhydramnios - Inertia - Abnormal
-Pressure symptom - Operative lactation
-Infection delivery
-Retinopathy
Risk of uncontrolled diabetes on fetus
1- Abortion
2- Congenital anomalies
Open neural defect, CHD, renal anomaly, sacral agenesis, small left colon syndrome(Approximately 40% to
50% of infants with this disorder have diabetic mothers, almost all of whom are insulin dependent , , imperforated anus.
3- Macrosomia
Fetal hyperglycaemia causes increase insulin secretion and lead to increase fetal fat deposition
Open neural defect
sacral agenesis
Macrosomia
Macrosomia
Macrosomia
Risk of uncontrolled diabetes on fetus
4- Intrauterine fetal death due to:
Congenital malformation, ketoacedosis, hypoglycaemia, superimposed PET.
5- Neonatal hypoglycemia
After delivery, glucose concentration fail, while neonatal insulin level remain high lead to neonatal hypoglycemia (Tremors, pallor, apnea, cyanosis)
Risk of uncontrolled diabetes on fetus
7- Hyperbilirubinaemia
Due to immature liver
8- Neonatal death due to:
Congenital anomalies
Gestational diabetes Mellitus is defined as:
“Glucose intolerance of any severity with onset or first recognition during pregnancy”
This definition is applicable irrespective of whether the condition resolves after delivery or not.
It does not exclude the possibility that diabetes could have antedated pregnancy.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
3. Introduction
• Diabetes in pregnant women is associated
with an increased risk for maternal and
neonatal morbidities and remains a
significant medical challenge.
• 650,000 births in England & Wales per year
• 2-5% women have diabetes
• 87% diabetic pregnancies due to gestational
diabetes
4. Introduction
• Prevalence diabetes is increasing
• Early diagnosis of gestational diabetes is an
important step to improve outcomes and
systematic or selective screening with the
OGTT should be established
• Perinatal mortality remains 5x higher
• Congenital malformations up to 10x more
common
5. Diabetes in Pregnancy
• Gestational Diabetes Mellitus (88%)
• Type 1 Diabetes Mellitus (4%)
• Type 2 Diabetes Mellitus (8%)
6. Definition
• ‘carbohydrate intolerance resulting in
hyperglycemia of variable severity with
onset or first recognition during pregnancy’
World health Organization, 1999
7. Statistics- Prevalence of GDM in
Malaysia
•N Idris et al -prevalence of GDM –18.3%
•Peng Chiong Tan, prevalence of GDM
-11.4%
•Nurain et al, prevalence of GDM – 16.1%
9. • Controversial
• Aim – early diagnosis is important to improve
outcomes
• Universal screening is recommended, but
currently using selective screening base on risk
factors
• Would vary according to
– Population
– (eg:asians>whites)
– Timing
– (high risk?average risk?low risk?)
– Screening tests-50 g
– Criteria used for diagnosis- WHO, ADA
10. Screening-Suggested (NICE
guideline 2008)
• Screening for gestational diabetes using risk
factors at the booking appointment
• Early self-monitoring of blood glucose or a 2-
hour 75 g oral glucose tolerance test (OGTT) at
16–18 weeks to test for gestational diabetes if the
woman has had gestational diabetes previously.
• Followed by OGTT at 28 weeks if the first test is
normal
• An OGTT to test for gestational diabetes at 24–28
weeks if the woman has any other risk factors.
11. Who should be screened
Clinical characteristics including
• Obesity
• Symptoms (polyuria, polydipsia)
• Personal history
• Glucosuria
• Family history
• Previous big baby
• Polyhydramnios
• Previous unexplained stillbirths/neonatal death
• History of recurrent vaginal candidiasis
24. Pre pregnancy Counseling
General guidelines:
•Pregnancy is planned,
•Explain risks of congenital anomalies and
spontaneous abortions – depends on glucose control
•Information on chronic complications and potential
impact on pregnancy and effect of pregnancy on
chronic complications
•Fitness for pregnancy –retinopathy, nephropathy,
HPT, neuropathy and IHD
26. Antenatal Management
Before or as soon as pregnancy is confirmed:
• Stop oral hypoglycaemic agents, apart from
metformin, and commence insulin if required
• Stop angiotensin-converting enzyme inhibitors
and angiotensin-II receptor antagonists and
consider alternative antihypertensives
• Stop statins.
27. Antenatal Management
• Dating Ultra sound first trimester
• Refer to Booking to Hospital with specialist
• Refer to Dietitian
• Consider Starting Insulin if target blood
glucose not achieve after 1-2 weeks on diet.
• Screen for Diabetic Retinopathy and
Nephropathy especially established Diab
early or at 28 weeks
28. Antenatal Management
• Antenatal examination of the four-chamber view
of the fetal heart and outflow tracts at 18–20
weeks
• Ultrasound monitoring of fetal growth and
amniotic fluid volume every 4 weeks from 28 to
36 weeks
• individualised monitoring of fetal wellbeing to
women at risk of intrauterine growth restriction
(those with macrovascular disease or
nephropathy).
29. Antenatal Management
• Not to allow post date in GDM on diet
control
• Deliver at 38 weeks if on Insulin Therapy
• To discuss mode and timing of delivery
based on assessment of glycaemic control,
insulin dosing and estimation of fetal
weight.
30. Outcomes of a diabetic
pregnancy to the fetus
EARLY PREGNANCY
• If glycemic control poor within first 8
weeks/ HbA1c >9.5% there is an increased
risk of spontaneous miscarriages and major
malformations
• Target Hb A1c 6.1%
31. Congenital malformations
• High maternal
glucose is toxic to the
early embryo – Risk
rises with worsening
glycaemic control at
conception and in early
first trimester
• Esp renal, cardiac
and central nervous
system abnormalities
32. Caudal regression syndrome
(sacral agenesis)
• The overall incidence: 1 in
7,500 live births.
• About 1 in 6 of patients is the
child of a diabetic mother.
• The risk for a child of a
diabetic mother of acquiring
the syndrome is 1%.
33. LATER IN THE PREGNANCY
• Incidence of abnormal fetal heart rate, low
Apgar scores is increased
• Higher risk of fetal asphyxia and distress
• Higher risk of stillbirths (d/t the chronic
fetal hypoxia)
34. Fetal macrosomia
• Hallmark of diabetic pregnancy
• High placental transfer of glucose leads to
hyperplasia of foetal pancreas and foetal
hyperinsulinaemia
• Insulin is the main growth hormone for the
foetus – hence macrosomia
• Brain growth is spared
• AC measured serially is the best
measurement for macrosomic fetuses
35. • Much of the excess weight
is truncal fat, hence
shoulder dystocia
• Macrosomia occurs in
25% of infants of type 1
diabetic mothers
• Excessive insulin secretion
persists after birth, →
hypoglycaemia
• Hyperglycaemia is the
main causative factor in
delayed lung maturation
36. Shoulder Dystocia with brachial plexus injury
9% when BW < 4 kg
26% when BW > 4.5kg
5-10% of infants have permanent brachial
plexus injuries.
Consider delivery by LSCS if suspected fetal
Macrosomia
Most likely due to poor Glycemic control
especially post pandial.
37. Hypoglycemia
• Most common cause of neonatal morbidity in
infants of diabetic mothers
• Maternal control during pregnancy and labour and
delivery will influence the degree of
hypoglycemia
• Neonatal hypoglycemia is usually asymptomatic
• Routine blood sugar monitoring is recommended
• A level of 2.6 mmol/L or above is generally
accepted
38. Established Diabetes
1 – 2% of the pregnant population.
Higher risk for Maternal complication with high
perinatal morbidity and mortality.
Effects of pregnancy of DM
• Insulin requirements increases during pregnancy
• Retinopathy aggravated
• Those with nephropathy more likely to have pre
eclampsia
• High risk of preterm delivery and asymmetrical
SGA
• Combine care important.
39. Summary of Management
Pre Pregnancy Planning necessary for good control
Switch from OHA to insulin
Women should be taught to monitor their own glucose
levels
HbA1c should be checked at booking
Pregnancy Aim to maintain normoglycemia
Antenatal follow ups should monitor blood pressure, look
for s/s of infection, fetal growth monitored by clinical
means as well as ultrasound
Delivery Aim for spontaneous delivery however usually induction
done at 38 weeks. If on diet control at EDD.
IV insulin and IV glucose (DIK) regime during labour
Beware of shoulder dystocia
40. Management
• Key to successful management is early diagnosis
• Early treatment
• Maintain good Glycemic control
• Early ultrasounds to exclude fetal abnormalities
• Attempt diet control (unless patient already
established diabetic)
• Followed by insulin if not controlled by diet
• Oral hypoglycemics should be avoided as risk of
teratogenicity in early pregnancy unless poorly
control despite high dose insulin.
41. Medication
• Metformin may be used before and during
pregnancy, Reserve for poorly control on high
dose insulin.
• Data from clinical trials and other sources do not
suggest that the rapid-acting insulin analogues
(aspart and lispro) adversely affect pregnancy or
the health of the fetus or newborn baby.
• Evidence about the use of long-acting insulin
analogues during pregnancy is limited. Isophane
insulin is the first-choice long-acting insulin
during pregnancy.
42. Delivery
• Timing of delivery depends on control
• If on insulin, the pregnancy is best terminated by
38 weeks
• If diet control is adequate then the pregnancy may
be prolonged to term
• Mode of delivery depends on clinical judgement
• Diabetes itself is not an indication for caesarean
• Factors favoring an elective CS are
– Macrosomia
– Suspicion of cephalopelvic disproportion
– Malpresentation
– polyhydramnious
43. During Labour:
• DIK regime used
• Infusion of 500ml of 10% Dextrose with 1 g
KCL to which an appropriate dose of
insulin added.
• Dose of insulin should be titrated
accordingly to hourly GM
• Adequate pain relief
• Continuous CTG
• Trained birth attendant
44. Postpartum
• Monitor for hypoglycemia/hyperglycemia
• Requirement of insulin halved post partum
• Consider restart back on OHA once taking normal
diet
• Advice breast feeding
• Schedule appointment for review of diabetes and
repeat MOGTT at 6/52
• Contraception advice, Life style modification
45. References
• World Health Organization Prevention of diabetes
mellitus. Geneva, World Health Org., 1994 .
• American Diabetic Association
• Australasian Diabetes in Pregnancy Society.
http://www.adips.org/
• Malaysian Clinical practice guidelines for management of
Type II Diabetes Mellitus. 4th
Edition. 2009
• Diabetes in Pregnancy. NICE. March 2008