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Antenatal care in Hyperglycemia in Pregnancy

Antenatal care in Hyperglycemia in Pregnancy. DR NAINA MIGLANI CONSULTANT Dayawati hospital. Antenatal care. Maternal surveillance Blood sugar control Watch for complications due to hyperglycemia Fetal surveillance Fetal well being Appropriate growth Congenital anomalies.

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Antenatal care in Hyperglycemia in Pregnancy

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  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 > 8% in first trimester, increased possibility of congenital malformations • If HbA1c > 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 > 95 mg/dl • Postprandial 2 hrs > 120 mg/dl • Any sugars <70 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 delivery< 34 weeks- careful blood sugar monitoring

  13. How to deliver? • Aim for vaginal delivery • LSCS for obstetric indications • Fetal weight >4kg 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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