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DIABETES IN PREGNANCY

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DIABETES IN PREGNANCY AHMED ABDULWAHAB CLASSIFICATION: INSULIN DEPENDANTDIABETES.I.D.D Diagnosis before pregnancy ,patient already in insulin usually young with ... – PowerPoint PPT presentation

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Title: DIABETES IN PREGNANCY


1
DIABETES IN PREGNANCY
  • AHMED ABDULWAHAB

2
  • CLASSIFICATION
  • INSULIN DEPENDANTDIABETES.I.D.D
  • Diagnosis before pregnancy ,patient already in
    insulin usually young with little or no insulin.
  • Non insulin dependant DM ,patient on oral
    hypoglycemic agents

3
  • STANDARD TEST FOR DIAGNOSIS
  • 75 gm of glucose orally after over night fast.
  • Fasting lt than 6 mmol one hour less than 11mmol .
    2hour lt9 . 3 hour should back to fasting level

4
  • GESTIONAL DIABETES
  • Diabetes occurs during pregnancy , will come to
    normal after delivery
  • INDICATION OF GTT
  • High GCT more than 7.8 mmol
  • Potential diabetes.
  • Unexplained IUFD
  • History of congenital anomalies

5
  • Glucose in urine more than twice
  • Maternal weight more than 90 KG
  • Previous big babies

6
  • WHY?
  • Pregnancy has diabetogenic effect .
  • There is a decreased sensitivity of insulin due
    to antagonizing effect by cortisone estrogen
    progesterone HPL , and degradation of insulin by
    placenta

7
  • GLUCOSE AND INSULIN RELATIONSHIP IN MOTHER AND
    FETUS.
  • Glucose cross placenta by facilitated diffusion.
  • Fetal pancreatic beta cell hypertrophy will
    increase the release of insulin.
  • Insulin is a potent stimulus to growth .

8
  • EFFECT OF PREGNANCY ON DIABETES.
  • Difficult to control
  • Lowered renal threshold and diminished
    sensitivity to insulin
  • Retinopathy. Need careful ophthalmic assessment ,
    there is increase prolifrative retinopathy
  • Nephropathy may be confused with hypertension and
    edema ,assess renal function

9
  • EFFECT OF DIABETES ON PREGNANCY.
  • Abortion.
  • Infection UTI fungal infection.
  • Pre eclampsia
  • Polyhydramnios
  • Prenatal death RDS anomalies
  • Macrosomia.

10
  • Cont.
  • Congenital anomalies poor control at early
    pregnancy, mainly CVS and CNS.
  • Caudal regression syndrome is specific.
  • Lung maturity, fetal insulin antagonize the
    effect of cortisone on surfactant .

11
  • MAAGEMENT
  • Combined care ,obstetrician and physician.
  • Without complication wait till 40 weeks
  • Food plan. 50 carbohydrate 20 protein 20 fat ,
    fiber
  • Majority need insulin short acting 2 or 3 doses
    may be required ..
  • Doses rise progressively with advancing
    pregnancy.
  • Oral hypoglycemic never to be used
  • Keep FBS between 4-6. 2h postprandial below 8
    mmol
  • HbA1C REFLECT average plasma glucose normal 6

12
  • OBSTETRIC CARE
  • Early pregnancy control reduce anomalies.
  • Late control reduce PET polyhydramnios and
    macrosomia .
  • Early booking for accurate dating.
  • Detailed USS ANOMALIES 18-20 WEEKS
  • Alpha fetoprotein
  • Regular follow up

13
  • DELIVERY.
  • Normal pregnancy wait 40 weeks
  • DM alone is not an indication for caesarian
    section
  • Induction of labor IOL Insulin infusion , hourly
    checking of blood sugar (sliding scale)
  • Close fetal heart monitoring .

14
  • POST PARTUM CARE .
  • Insulin requirement fall rapidly after delivery
  • Infant of diabetic mother has the following
    problems.
  • Over weight, plethoric ,RDS, hypoglycemic.
  • Hyperbilurbinaemia hypocalcaemia.
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