Gestational diabetes

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

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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...

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