Obstetrical management of patients with diabetes in pregnancy.
The management of the woman with diabetes diagnosed before the onset of pregnancy, or who develops it during pregnancy, requires a team approach involving the woman and her partner, the diabetes nurse educator, the dietitian, the endocrinologist, the obstetrician, the ultrasonologist and the paediatrician. It should start before pregnancy so that normoglycaemia is achieved before conception and maintained throughout gestation and labour. Fetoplacental surveillance commences with an early ultrasound to confirm fetal viability, repeated around 20 weeks to exclude major fetal malformations and then later in the third trimester to monitor fetal growth. CTG and biophysical profile assessment are major adjuncts to ensuring fetal well-being. The pregnancy should be allowed to go to full term when maternal blood glucose control has been satisfactory, fetal growth is within the normal range and other obstetrical complications, e.g. pre-eclampsia, are absent. Such an approach will ensure that the caesarean section rate can be minimized. During labour, the progress of labour and fetal well-being should be closely monitored. The woman who has microvascular complications of her diabetes (including proliferative retinopathy and nephropathy) requires even closer surveillance and premature delivery is more likely to be needed. The principles of management of the woman who develops gestational diabetes are similar, with even greater emphasis being placed on not inducing labour before full term unless complications dictate otherwise.
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D036861:Delivery, Obstetric; D016640:Diabetes, Gestational / Q000628:therapy*; D005260:Female; D005333:Fetus / Q000502:physiology; D006801:Humans; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000628:therapy; D011254:Pregnancy in Diabetics / Q000150:complications / Q000628:therapy*