YAYIN OB

GESTATIONAL DIABETES MELLITUS  H

 Cardiopathy is present
 A pregnancy complicated by DM
 R
 May be due to the presence of Human Placental
 With active retinitis proliferance
Lactogen ( HPL )
 T
 Placental insulinase may cause increase insulin
 Kidney transplant
breakdown

DIABETES MELLITUS
DIAGNOSTIC EXAMINATION
 An endocrine disorder in which the pancreas is unable to
produce adequate insulin to regulate body glucose 1. GLUCOSE TOLERANCE TEST

 usually done at 24 -28 wks AOG

PREDISPOSING FACTORS
 1 hr GTT – woman is given oral 50 gram glucose load
1. Obesity Reference Value : 140 mg/dl
2. Age over 30 years  3hr GTT – woman is given oral 10 gram glucose load
3. History of Low Gestation Age (LGA) babies Reference values : 1h – 190 mg/dl
4. History od unexplained fetal loss 2h – 165 mg/dl
5. History of congenital anomalies in previous pregnancy
6. Family history of DM 3h – 145 mg/dl

CLASSIFICATIONS
2. ALPHA-FETOPROTEIN TEST
 A
 GTT is slightly abnormal  done at 15 – 17 wks AOG to assess neural tube defect.
 Dietary regulation is minimal  could be done to maternal blood or to the amniotic fluid
 No insulin required  normal value : <40 mg/ml

 B
 DM less than 10 yrs duration or DM began at 20
years or above
 No vascular involvement
 C
 DM began between ages 10 and 19 yrs
 Whose disease has lasted from 10-19 yrs
 Minimal vascular involvement
 D
 DM lasted 20 yrs or more
 whose disease began before 10 yrs
 greater vascular involvement
 D1 : under age 10 yrs onset
 D2 : More than 20 years duration
 D3 : Beginning retinopathy is present
 D4 : Calcified vessels of legs are present
 D5 : Hypertension is present
 E
 Pelvic artery calcification is demonstrated by X-ray
3. SONOGRAM
 done approximately 18 – 20 wks AOG to detect gross
abnormality
 done again on the 28th wk then on the 36th & 38th wk of
pregnanxy to determine fetal growth, amniotic fluid
volume, placental location and biparietal diameter.
4. CREATININE CLEARANCE TEST
 ordered each trimester
 assess intact vascular system and adequate uterine
perfusion
 normal cvalue : 87 – 107 ml/min
5. LECITIN – SPHYNGOMYELIN RATIO
 done by amniocentesis on the 36th wk AOG
 assess fetal lung activity
 normal ratio 2:1

 F
 Nephropathy is present
YAYIN OB
6. NON – STRESS TEST

 done weekly to determine placental functioning

7. FETAL MOVEMENT MONITORING

 determines fetal activity

 normal value : approximately 10 movements per hour

8. BIOPHYSICAL PROFILE ( FETAL APGAR )

 determines fetal well being

COMPLICATIONS

1. LGA baby
2. Polyhydraminos
3. Perinatal mortality
4. PIH
5. Neural Tube Defect
6. CS Delivery
7. Cephalopelvic Disproprotioned
8. Prematurity
9. Neonatal hypoglycaemia
10. Neonatal death due to RDS
11. Maternal Infection
12. Postpartal haemorrhage
13. Ketoacidocis
14. Abortion

MANAGEMENT

1. Diet : Diabetic Diet

2. 1800 – 2200 cal intake per day ; high fiber. Low fat
3. Insulin therapy
4. Exercise : 30 mins walking per day
5. Blood glucose monitoring
6. Fetal and maternal well-being assessment
monitoring