Gestational diabetes

Gestational diabetes - 3. Intrapartum care Aim for vaginal...

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Gestational diabetes Treatment 1. Pre-pregnancy Optimal control of pre-existing DM Convert from oral hypoglycaemics to insulin** for better glycaemic control 2. Antenatal care Management of diabetes should include a consultant, plus a community team and with joint endocrine and obstetric management. Encourage appropriate dietary control (low-sugar, low-fat, high fibre diet). This + home glucose monitoring (e.g. LifeScan Ultra Easy glucose monitor) may be sufficient in GBM. If not, diet+insulin is used. Aim for tight control with post-prandial (after-eating) BM<7 and avoid hypos. Monthly HbA1c measurements should be taken. In pre-existing DM, fundoscopy should be done regularly to look for retinopathy. USS scans are important, including the 20 week anomaly scan (+/-detailed cardiac scan in pre- existing diabetics) and serial growth scans/AFI assessment + Doppler USS if necessary.
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Unformatted text preview: 3. Intrapartum care Aim for vaginal delivery at term. If poor control of diabetes or macrosomia baby consider caesarean section at 39 weeks. Insulin sliding scale can be used in vaginal birth labour. However if there are any signs of maternal or foetal distress, convert to lower segment caesarian section. Involve the paeds team, as the baby is more likely to be hypoglycaemic at birth. After delivery, pre-existing DM can return to pre-pregnancy medication and GDM can stop the insulin. 4. Follow-up: An OGTT should be performed 6/52 after delivery as these women are at an increased risk of developing NIDDM later in life. Prevention There are no known preventative measures for gestational diabetes...
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Gestational diabetes - 3. Intrapartum care Aim for vaginal...

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