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Diabetes in Pregnancy

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JEAN KALIBUSHI B. ,MD Resident in GO at Butare teaching hospital ANAMNESIS A known diabetic patient ,34years old MC: transfert from outpatient for better menagement ... – PowerPoint PPT presentation

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Title: Diabetes in Pregnancy


1
Diabetes in Pregnancy
  • JEAN KALIBUSHI B. ,MD
  • Resident in GO at Butare teaching
  • hospital

2
CASE REPORT
3
ANAMNESIS
  • A known diabetic patient ,34years old
  • MC transfert from outpatient for better
    menagement of Cervical incompetence on 16 weeks
    5days of amenorrhea
  • ATCDsG3POEVOA2
  • LMP15/09/2007
  • MEDICAL Diabetic since 28/dec/2007,on 20UI/day
    of long acting insulin
  • SURG myomectomy on 2004

4
NEXT
  • Tobacconever taken
  • Alcohol stopped since 2years 1/2

5
CLINICAL EXAM
  • Vital signs NAD
  • Thorax NAD
  • Abdomen HF 16cm
  • Gyneco.Ex not done on admission
  • CCL Cervical incompetence(BCI) on diabetic
    history whith pregnancy of 16weeks5days of
    amenorrhea

6
MANAGEMENT
  • Admission programmation of cerclage
  • Pre-op test Normal range
  • On 10/01/08 cerclage done

7
FOLLOW UP OF BLOOD SUGAR
  • On 10/01/08,On 20UI/day of long acting insulin
  • -204mg/dl M
  • -280mg/dlEVEN
  • On 11/01/08
  • -245mg/dlM
  • -187mg/dlEVEN

8
NEXT
  • On 12/01/08
  • -112mg/dlM
  • On 13/01/08
  • -185mg/dlM
  • -164mg/dlS
  • On 14/01/08
  • -118mg/dlM

9
NEXT
  • On 15/01/08
  • -172mg/dlM
  • On 19/01/08 206mg/dlM
  • On 21/01/08 138mg/dlM
  • On 23/01/08 141mg/dlM
  • On 24/01/08 176mg/dl, change of dose at 26UI of
    long acting Insulin in the morning and discharged
    the same day

10
READMISSION
  • On 23/feb/08 for pre-term labor of 23weeks of
    amenorrhea
  • Management READMISSION
  • Blood sugar on empty stomach157mg/dl on 26UI of
    rapid insulin and buscopan
  • On 24/01/08 Discharged again

11
LITTERAL VIEW
12
  • DEFINITION
  • Diabetes is a metabolic disease of CH due to
    relative or absolute deficiency in insulin.
  • Gestational diabetes Carbohydrate intolerance
    with onset or recognition during pregnancy.
  • WHO Classification
  • TypeITypeII and Gestational diabetes
  • I II Chronic conditions
  • Gest Diab. typically resolves with delivery of
    the child

13
EPIDEMIOLOGY
  • Most common medical complications of pregnancy.
  • 2 of all pregnancies affected by Diabetes
  • 1 are GDM
  • USA 3-5 among them
  • 10 pregestational(Type 1 2)
  • 90 Gestational

14
PATHOPHYSIOLOGY
  • GD is similar to type 2 DM with a relative
    deficiency in insulin and insulin resistance.
  • Type1 early in life, destruction of Langerhans
    cells.
  • GD Placenta produces hormones
    (hPL,P4,Cortisol,PGH,) that antagonize insulin
    and reach max levels at 24 to 28 weeks. Early in
    pregnancy as a result of higher levels of
    estrogen, insulin sensibility will increase
    making diabetes patient more prone to
    hypoglycemia. In last 1/3 of gestation 40 of
    pregnant women become relatively insulin
    resistant and must secrete 3-4 X more insulin to
    maintain normal blood glucose level.

15
RISK FACTORS
  • Agegt25 years
  • Strong familly ATCD of DM
  • Prior atcd of new born weigthgt4000g.
  • Obesity (BMI 30)
  • Repeated spontaneous abortion
  • Unexplained stillbirth or congenital abnormaly.
  • Persitant glucosuria
  • Polycystic ovarian sd.

16
Maternal affects
  • 2x risk of UTI
  • 2x risk of Pregnancy induced hypertension
  • 2x risk Preeclampsia
  • DKA (Peripartum mortality)
  • Retinopathy
  • Nephropathy
  • Postpartum hemorrhage

17
Fetal effects
  • 1-2 increased risk of anomalies
  • Cardiac
  • Limb
  • Sacral agenesis
  • Renal
  • CNS abnormalities
  • Macrosomia gt4500g
  • Polyhydramnios (gt2000ml)
  • Stillbirth

18
Neonatal effects
  • Hypoglycemia
  • Hyperbilirubinemia
  • Hypocalcemia
  • Polycythemia
  • Pulmonary immaturity
  • Organomegaly

19
SCREENING
  • Fasting gt125, 1hr PP gt200
  • 2 hr GTT
  • 1 hour 50g glucose challenge gt130-140
  • 3 hour 100g glucose tolerance test Fasting gt95,
    1hr gt180, 2hrgt155, 3 hr gt140
  • 2 or more abnormal values makes the diagnosis

20
WHITE Classification
  • A1GDM diet controlled
  • A2GDM requiring medical therapy
  • B Onset after age 20, duration lt10yr, No
    vascular
  • C Onset between 10-19, duration 10-19yrs, no
    vascular disease
  • D Onset ltage 10, duration gt20yrs, retinal or leg
    involvement
  • F Vascular nephropathy
  • R Retinopathy
  • H Coronary artery diseases.

21
TREATMENT
22
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25
0bstetric Complications
26
REFERENCES
  • 1.Lauren N. et al.Current diagnosis and treatment
    in GO.10th edition.2007.
  • 2.Gabbe SG, Graves CR. Management of diabetes
    mellitus complicating pregnancy.Obstet Gynecol
    2003102857-868.
  • 3.ACOG.Pregestational diabetes mellitus.Obstet
    Gynecol 2005105675-685.
  • 4.Gary F.Williams obstetrics.22nd edition.2005.
  • 5.Kakudji.Cours de GO.Université de
    Lubumbashi.2003.

27
MURAKOZE
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