pre pregnancy advice with dm1 81

Question 1

HX

Answer 1

-when were you first diagnosed
-what treatment
-is it well controlled?
-diabetic r/v last, check CBS tds and maintain values 6-8.
-UTI, vaginal infections?
-RFT, eye?
-hyperglycaemic coma episodes? but had hypoglycemia
-routine : FBC, rubella, syphyllis, indirect coombs

Question 2

pre-pregnancy councelling

Answer 2

1. assess diabetic control
   -Need HBA!c
   -maintain blood glucose levels 5-7(reduce fetal malformation, iud, macrosomia)
   -refer diabetic physician : polyneuropathy, RFT
   -Ophthalmologist: fundal exam
   2.If above normal
   -routine tests prior to pregnancy
   (FBC, serology, vdrl, mid stream urine, coombs, grouping)
   -refer to obgyn, and diabetic
   -***insulin requirement will markedy increase,
   -insulin requirement back to prepreg levels 24 hrs after sx
   -uss 12/a8 for anomalies 32 fr macrosomia
   -iron folic acid throighout

Question 3

delivery

Answer 3

38-40weeks

Question 4

risks

Answer 4

pre-eclempsia, IUD, macrosomia, polyhyraminos
resp distress after delivery