best diaetes services

1
Antenatal care in Hyperglycemia in Pregnancy

• DR NAINA MIGLANI
• CONSULTANT
• Dayawati hospital

2
Antenatal care

• Maternal surveillance
• Blood sugar control
• Watch for complications due to hyperglycemia
• Fetal surveillance
• Fetal well being
• Appropriate growth
• Congenital anomalies

3
Counselling

• Reassure
• Reassure
• Reassure

4
Antenatal check upFirst visit
5
Counselling

• If HbA1c gt 8 in first trimester, increased
  possibility of congenital malformations
• If HbA1c gt 9.5 in first trimester, 22 risk of
  congenital malformations
• If presence of end organ disease, more chances of
  fetal compromise and not so favourable outcome of
  pregnancy

6
Antenatal Check upEvery visit

• Hemoglobin
• Urine routine exam
• Blood pressure
• Fundal height
• Clinically evaluate for hydramnios

• Blood sugar testing every 2 weeks on her own by
  glucometer and by venous blood sample
• Diet counselling
• Exercises
• Insulin if required and patient is educated to
  administer insulin herself

7
Antenatal care

• Routine Iron and calcium supplements
• Tetanus immunization
• Counsel for possibility of preterm labour
• If preterm labour
• Admit
• Tocolysis with nifedepine or magsulf
• Sympathomimmetics to be avoided
• Corticosteroids
• Important to be regular for antenatal checkup
• Explain how to monitor blood sugars

8
Fetal surveillance

• Accurate Dating by ultrasonography in first
  trimester
• USG at 18-20 weeks for congenital anomalies
• Fetal echocardiography in women with preexisting
  diabetes, diabetes diagnosed in early pregnancy
• USG in 3 rd trimester for fetal growth evaluation
• Daily fetal movement count

9
Danger signs

• Blood sugars
• Fasting gt 95 mg/dl
• Postprandial 2 hrs gt 120 mg/dl
• Any sugars lt70 mg/dl
• Symptoms of hypoglycemia like sweating, syncopal
  attacks
• Pain abdomen, leaking or bleeding pv
• Reduced fetal movements
• Admit if any above or compromised maternal and
  fetal surveillance

10
Featl surveillance

• Women with previous stillbirth
• Associated preeclampsia
• Requiring insulin
• Preexisting diabetes

Twice weekly NST and doppler assessment as and
when required
11
Planning delivery
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When to deliver?

• GDM well controlled on diet to be followed till
  41 weeks
• GDM on insulin pregnancy terminated at 38-39
  weeks by induction of labour
• Earlier termination of pregnancy if associated
  hypertension or compromised fetal testing
• Antenatal corticosteroids to be administered if
  deliverylt 34 weeks- careful blood sugar
  monitoring

13
How to deliver?

• Aim for vaginal delivery
• LSCS for obstetric indications
• Fetal weight gt4kg consider elective cesarean
  section

14
Intrapartum care

• No definite protocol
• Gestational diabetics in labour do not require
  insulin and only blood sugar monitoring
• Omit morning dose of insulin if elective cesarean
  section
• Night doses as usual
• In induction of labour, omit the dose when in
  active labour
• Blood sugar monitoring at regular intervals and
  insulin accordingly

15
Intrapartum care

• Fetal heart to be closely monitored in labour
• More chances of prolonged labour
• More instrumental delivery
• Watch for
• Shoulder dystocia
• Birth injuries
• PPH