Obs - DM in Pregnancy

Question 1

A lady at 27 weeks of gestation. OGTT 7.8/14

Diagnosis and management?

Answer 1

DM in pregnancy

Review past glycemic control
Hx and Initial workup for complications: MSU for bacteriuria, RFT and spot urine protein:cr ratio for nephropathy, fundoscopy/refer for retinopathy
Admit for insulin

Refer to DM class by nurse and dietician
Subcutaneous insulin + CBG monitoring
Aspirin and folic acid prophylaxis
Monitor USG fetal growth, amniotic fluid vol, for EFW + weekly CTG

Mode of delivery
uncomplicated: elective IOL at 37-38wk gestation, monitor CBG, Insulin infusion using syringe pump according to sliding scale
LGA: Elective CS before 37wk

Question 2

Given fetal growth chart, AC is over 97th percentile

Answer 2

Macrosomia (>4kg, some AC +2SD) / LGA

Question 3

What would you like to monitor?

Answer 3

Maternal:
Frequent CBG monitoring
BP monitoring and urine multistix for PET

Fetal:
Weekly CTG
Morpho scan at 20w
USG every 4 week (28/32/36) for efw
Intrapartum: hourly CBG monitoring