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Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries. For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources. The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms. The WDF mission: – PowerPoint PPT presentation

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Title: 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
12
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
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