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DIBESTES IN PREGNANCY

Learn about diabetes in pregnancy, its effects on mother & baby, symptoms, diagnostic criteria, management strategies, delivery methods, and postpartum care.

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DIBESTES IN PREGNANCY

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  1. DIBESTES IN PREGNANCY Presented by DR H. AZADEH MD Senior Consultant and Senior Lecturer In Obstetrics & Gynaecology Medical School University of the Gambia

  2. DIABETES IN PREGNANCY • Definition • Aetiology • Signs and Symptoms • Classification and Diagnostic criteria • The effect of pregnancy on diabetes • The effect of diabetes on pregnancy

  3. DIABETES IN PREGNANCY • Blood glucose and insulin relationship in mother and foetus • Management of pregnancy complicated by diabetes • Obstetrics management • Delivery • Postpartum • Complications

  4. DIBETTES IN PREGNANCY • Diabetes is a metabolic disease which results from underproduction of insulin by the pancreas. • This results in disturbances of carbohydrate, fat and protein metabolism lead to sustained rise in blood glucose

  5. DIABETES IN PREGNANCY • During the pregnancy, diabetes may be one of following: • 1) Pre-existing diabetes which is usually insulin dependent- established as diabetes mellitus • 2) Discovered for the first time in pregnancy, this is known as gestational diabetes

  6. DIABETES IN PREGNANCY • Signs and Symptoms of diabetes • Weight gain or losing weight • Thirst • Polyuria with glucose • Hyperglycaemia • Tendency to Ketoacidoses

  7. DIABEYTES IN PREGNANCY • Classification and diagnostic criteria • Type 1 Insulin dependent diabetes • Type 2 none insulin dependent diabetes • Type 3 Gestational diabetes

  8. DIBETES IN PREGNANCY • Diagnostic assessment • Taken full present history and also in particular family history of diabetes • Blood test, FBS, RBS and GTT test • GTT test ( 75 mg glucose in 250-300 ml water taken orally 5-15 minutes after over night fasting

  9. DIABETERS IN PREGNANCY • The effect of pregnancy on diabetes • Placenta produces the following hormones: • Oestrogen, Progesterone and human placenta lactogen ( PHL ) together with a changing in peripheral insulin receptors

  10. CONTINUE • Glucose crosses the placenta by facilitating diffusion of glucose, so that the foetus has certain glucose level • This called the blood glucose and insulin relationship in mother and foetus

  11. CONTINUE • The effect of the diabetes on pregnancy • Poorly controlled diabetes women are sub-fertile • Improving control of diabetes increase the chance getting pregnant, • while pregnant without diabetes control high rate of miscarriages in first and second trimesters!!!!!

  12. CONTINUE • Increase associated with the death of the foetus • Increase congenital abnormalities ( 50% are neural tube defect, 30 % are cardiac abnormalities ) • Increase in the incidence of pregnancy –induce hypertension

  13. CONTINUE • Increasein the incidence of preterm delivery • Increase in the incidence of polyhydramnious • Increase risk of sudden IUD in the last 4 weeks of pregnancy

  14. CONTINUE • Incidence of macrosmic infants which may results in extremely difficulties of delivery, particularly shoulder dystociat • Increase in severe placenta insufficient • Increase in placenta abruption • Furthermore increase of UTI’s • Increase in Vulvitis, Vaginitis

  15. CONTINUE • Increase of birth’s trauma • Increase of asphyxia during delivery • Increase of risk of respiratory distress syndrome • Hypoglycaemia • Hyperbilirobinaemia - jaundice

  16. CONTINEU • MANANGEMENT • Pre pregnancy care • All insulin dependent diabetic patients of reproductive age should take appropriate contraceptive

  17. CONTINUE • They should be counselled about pregnancy related risks and complications • When getting pregnant, their diabetic condition must be regularly controlled, monitored with consultation with a diabetes specialist colleague

  18. CONTINUE • Advice on strictly diet during pregnancy, continue taking their medication post- partum breastfeeding and appropriate contraceptive • Regular visit to the clinic for follow up and lab investigations

  19. CONTINUE • Method of safe delivery • In sever diabetic patients, recommended induction should be carried out between 37-40 weeks gestation • Caesarean section should be carried out strictly on appropriate obstetrics indication and must be performed by an experienced colleague

  20. CONTINUE • Control of diabetes during labour is achieved by i.v. Insulin infusion or with i.v. glucose and monitored every half and hour • Labour should be accelerated with syntocinon drip and pain-relife • Be fully prepared for all these expected complications

  21. The End • THANK YOU FOR YOUR ATTENTION

  22. CONTINUE • Immediate care of the baby • The following features are important: • Resuscitate the baby if required • Dry the baby and keep it worm • Perform a blood test for blood sugar • Give oxygen to improve respiration

  23. FINALLY THANK YOU FOR YOUR ATTENTION

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