GDM case presentation overt dm

1. CASE PRESENTATION ON GDM

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

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. 29/12/23: HbA1c - 6.2, PPBS - 117
2. 30/12/23: Lipid profile - WNL
3. 31/12/23: PPBS - 82
4. 1/1/24: FBS - 74
LABORATORY INVESTIGATIONS

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 Systematic examination:
Cardiovascular system - S1 and S2 heard. No murmur heard.
Respiratory system - Normal vesicular breath sounds heard. No added sound
heard.
Central nervous system examination:
Patient well oriented to time, place and person. No focal neurological deficit.
Ophthalmological examination- No papilloedema or other abnormality noted.
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

9. 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

10. 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

11. MEDICATIONS DURING COURSE OF STAY

12. PROVISIONAL DIAGNOSIS

13. 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.

14. 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 Oph 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.