Case Study of

Cesarean Section with

Gestational Diabetes Mellitus
Patient’s Profile

Px: AJ
o Name of Patient: AJ 
o Age: 29                                           Physician: Dr. L Junieboy Carmelle Magallones 
o Date of Birth: July 9, 1993
o Status: Married                              Obstetrician: Dr. Therese Batumbakal  Faunillan 
o Sex: Female
o Nationality: Filipino                         Pediatrician: Dr. Bebe Bongcaras 
o Religion: Roman Catholic 
o Address: Poblacion Sur, Carmen, Bohol 
o Occupation: Ticket Collector 

o Room: Labor Room 

o Bed No: 2 
o Date of Admission: October 23, 2022 
o Date of Delivery: October 23, 2022 
o Type of Delivery: Cesarean Section
 Chief Complaint 

• Patient AJ was scheduled for a Cesarean Section at the hospital on October 23, 2022
at ACE Medical Center due to gestational diabetes mellitus. Her AOG is 39 weeks and
2 days according to her LMP which was January 23, 2022. 

 History of Present Illness: 

• Patient AJ is a G2P2 and has a previous history of macrosomia which was also
delivered through a cesarean section. Patient was diagnosed with gestational diabetes
mellitus (GDM).

 Diagnosis

• Gestational Diabetes Mellitus

 Obstetric Diagnosis:

• G2P2 ,Uterine, 39 weeks and 2 days AOG, term, cephalic, delivered, c-section
  Illness in the Past

 Childhood – None

 Adolescent – None

 Adulthood – Hypertension

 Travels – None

 Accidents Trauma: None

 Vital Signs (present/upon receiving):

      Temperature: 37.0°C

      Pulse Rate: 127 bpm

      Respiratory Rate: 29 bpm

      Blood Pressure: 180/90 mmhg

      Pupils: PERRLA

      Height: 164 cm

      Weight: 90kg
 Perceptions And Expectation or Present Illness/ Hospitalization

 Why did the patient came to the hospital?

       "Misakit siya ug taman, manganak nako", as verbalized by the patient.

 Other questions was not answered due to patient's uneasiness.

 Habits of Daily Living

 Meal Pattern                  Time                                 Usual Food

 Breakfast:                      7 am                                 Fried Foods

 Lunch                            11 am                                Meat, Pork
 Dinner                            6pm                               Meat, Pork, Chicken
 Snacks                      9 am and 3 pm           Bread, Sweets, Junk foods, Fruits

   Food Dislikes : Vegetables

   Food Allergies : Seafoods

 Fluid Habits 

     Fluid Preferences: Water, Soft drinks, Milk

     Fluid Dislikes: Alcoholic Beverages

 Sleep Habits            
   At home: Snore               
    Wakes up at the middle of the night to urinate

 General Hygiene           

  Bathing: Everyday
  Dental Care: Scheduled for check-up every month

 Irregularities :   Increased urine output

      
 Biophysical Scoring: Fetus is large for gestational age
 Nurse Impression: 

 The General body structure of the patient appeared to be broad.

Displayed an anxious emotional status and appeared to be tense.
Pathophysiology
 PATHOPHYSIOLOGY
        Controlling the balance between insulin and blood glucose levels to avoid
hyperglycemia or hypoglycaemia is the primary concern for any woman with these
disorders. Both conditions are risky during pregnancy, but also because normal fetal
development is jeopardized. Babies born to mothers who have uncontrolled diabetes
are five times more likely to be born big with gestational age or with birth defects.

      
           A woman who has diabetes that is not well controlled has a higher chance of
needing a C-section to deliver the baby. When the baby is delivered by a C-section, it
takes longer for the woman to recover from childbirth. In pregnant women with
gestational diabetes mellitus (GDM), the overall cesarean section rate was accounted
for 35.3%. Simultaneously, compared with nondiabetic pregnant women, diabetic
maternal acute cesarean section rate was reported 1.52 times of GDM.
 What is a Cesarean-Section?

• Cesarean section, C-section, or Cesarean birth is the surgical delivery of a baby through a
cut (incision) made in the mother's abdomen and uterus. Health care providers use it when
they it is safer for the mother, the baby, or both. The incision made in the skin may be: Up-
and-down (vertical).

• Moreover, while a normal procedure involves a vaginal delivery, a C-section procedure

entails a surgical slit in the mother's abdomen, from which a baby is manually extracted.
Because a C-section delivery involves sutures to stitch up the incision, recovery from a C-
section procedure usually takes longer.
 C-Section is Recommended if:
• The mother is carrying more than 1 baby (twins, triplet, etc.)
• The mother has health problem including HIV infection, herpes infection or heart diseas;
• Health problems and/or complications (Hypertensive, problems of the placenta, position of the
baby)
• Had previous C-section
• When labor isn't progressing
• Baby is in distress

 What is C-section infection

Harmful microbes coming into contact with the C-section wound cause the infection. The bacterium
Staphylococcus aureus is the most common microbe to cause C-section wound infections. Other
common types of bacteria that can cause the infection include Enterococcus and Escherichia coli.
Clinical Manifestations:
• Severe abdominal pain
• Redness, swelling and/or pus discharge of the incision sight
• Pain gets worse or does not go away
• Fever
• Dysuria (Painful/difficulty in urinating)
• Foul-smelling vaginal discharge
• Bleeding containing large clots and that soaks feminine pad within an hour
• Leg pain or swelling (edema)
Gestational Diabetes mellitus

Gestational diabetes is a type of diabetes that can develop during pregnancy in women who don't
already have diabetes. For this reason, the baby is “overfed” and grows extra-large.
Besides causing discomfort to the woman during the last few months of pregnancy, an extra-large
baby can lead to problems during delivery for both the mother and the baby. Furthermore, in most
instances, gestational diabetes is short term, with blood sugar levels reverting to normal once
pregnancy ends.

What Causes Gestational Diabetes?

Gestational diabetes occurs when your body can't make enough insulin during your pregnancy.
Insulin is a hormone made by the pancreas that acts like a key to let blood sugar into the cells in
the body for use as energy.
Risk factors:
• Overweight/obese

Complications:
• Extra-large baby
• Pre-eclampsia(High blood pressure)
• Hypoglycaemia
Management:

• Monitoring blood sugar

• Maintaining a healthy diet
• Exercise (with doctors consent)
• Use medication (as prescribed)