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Post Partum

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Discuss the immediate care of the infant Discuss the importance of breast feeding Discuss follow up screening of the mother Discuss risk of IGT or diabetes in future Discuss follow up education for mother – PowerPoint PPT presentation

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Title: Post Partum


1
Post Partum
2
Objectives
  • Discuss the immediate care of the infant
  • Discuss the importance of breast feeding
  • Discuss follow up screening of the mother
  • Discuss risk of IGT or diabetes in future
  • Discuss follow up education for mother

3
After delivery the infant
  • Watch for signs of hypoglycemia
  • Check blood glucose heel prick
  • Within 1st hour after delivery
  • After each of 1st 4 feeds
  • Less than 2.6 mmol/L or 44 mg/dl defined as
    hypoglycemia
  • Treatment of hypoglycemia
  • Topfeeding/glucose in water/ IV dextrose

Seshiah, Balaji, 2006
4
After delivery the infant
  • Usual care
  • Vital signs
  • Apgar scores
  • Pre-warmed incubator
  • Start breast feeding within 30 minutes for better
    latching
  • Watch for jaundice check bilirubin
  • If macrosomic, check calcium and magnesium on day
    2

Seshiah, Balaji, 2006
5
After delivery - mother
  • Exogenous insulin not required after placenta is
    delivered
  • Blood glucose usually returns to normal
  • Check fasting within 48 hours to rule out type 1
    or type 2 diabetes

6
Breast feeding
  • Encourage for all
  • Protects infant from over or undernutrition
    during early childhood
  • May lower risk of
  • Obesity
  • Hypertension
  • Cardiovascular disease
  • Diabetes

Gunderson, 2007
7
Post partum period
  • Encourage mother to achieve healthy weight.
  • Healthy eating
  • Adequate intake to sustain breast feeding
  • Regular activity

8
Future pregnancies
  • Should be planned
  • Education regarding birth control is needed
  • Encourage achieving healthy weight prior to
    conceiving again
  • Check blood glucose levels well ahead of
    conception allowing time to normalize if necessary

9
Contraception
  • Any method of contraception can be safely used in
    a woman with history of GDM
  • Intrauterine devices are commonly used
  • Progesterone-only oral contraceptives are the
    best choice within the first 6 weeks post partum
  • They have the lowest risk of thrombosis
  • Preferred during breastfeeding

10
Glucose tolerance testing
  • Should be done 6-12 weeks post partum
  • Fasting glucose testing is not sufficient to
    identify all who have IGT or type 2 diabetes
  • Only 34 of women with IGT or type 2 had elevated
    fasting glucose levels
  • 44 of those with type 2 had fasting less than
    5.5 mmol/L (100 mg/dL)
  • OGTT should be done

Metzger, Buchanan, Coustan et al. 2007
11
CVD risk
  • Women with GDM may have many of characteristics
    of metabolic syndrome
  • Hypertension, dyslipidemia, obesity, IGT should
    all be evaluated and treated

Metzger, Buchanan, Coustan et al. 2007
12
Postpartum education is key
  • OGTT at 6-12 weeks
  • Managing risk factors
  • Obesity
  • Hypertension
  • Dyslipidemia
  • Birth control
  • Preconception screening
  • Annual screening for diabetes 35-60 risk of
    type 2 within 10 years

Metzger, Buchanan, Coustan et al. 2007
13
References
  • Gunderson EP. Breastfeeding after gestational
    diabetes pregnancy. Diabetes Care. 200730(suppl
    2)S161-168.
  • Metzger BE, Buchanan TA, Coustan DR, De Leiva A,
    Hadden DR, Hod M. Summary and recommendations of
    the fifth international workshop-conference on
    gestational diabetes mellitus, Diabetes Care.
    2007 30(suppl 2)S251-260.
  • Seshiah V, Balaji V, et al. Gestational Diabetes
    Mellitus Guidelines. J Assoc Physic of India
    200654622-28.
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