Diabetes Mellitus Complicated Pregnancy

7/25/2019 Diabetes Mellitus Complicated Pregnancy

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CASE 02



• Name :

•

Age : 36 years• House Wife

• From:

• In her 3rd pregnancy

• Known patient with type 2 diabetesmellitus

• Admitted due to ba! pain and "ower

abdomina" pain for # da$sat 36wks of POA



%ast &bs Histor$

1st pregnancy (2005

• '$ a N()* at term +#, wee!s-

• 'irth weight 2.,/0 Kg

• No materna" or feta" omp"iations

•Current"$ : $ear o"d bo$

!ype 2 "# diagnosed in 200$ ($ years ago

Was on*

1etformin 00mg b.d

3"iben"amide mg b.d



2nd pregnancy +200-

• '$ a N() at term +#, wee!s-

• 'irth weight #./,0 Kg

• Antenatal period was complicated wit%type 2 "#

•

&nsulin from the onset of pregnan$ up tode"i4er$

• 'aby was in &)* for # da$s formonitoring

• / $ears o"d gir"

• )iagnosed with +ypot%yroidism in 205#

and has been on th$ro6in sine then



Current %regnan$

• Not a p"anned pregnan$

• Was not on preconception folic acid

• It was on7rmed b$ a urine dip test on 8th wee!of %&A due to absene of periods for # wee!s.

•

91% on #rd

)eember 205#• She is sure of the dates.

• She had regu"ar menstrua" $"e of 2 da$s*b"eeding "asted for # da$s.

• She was not on an$ hormona" ontraepti4emethods.

• herefor E)) is on 50th September 205; andPOA 36 weeks



At oneption*

• She was on 1etformin 00mg b.dand g"iben"amide mg b.d unti" 8th wee!

• hereafter Insu"in aspart

• Not sure if )1 was under ontro" atthe time of oneption

• Has had e$e referra"



5st rimester

• 'oo!ing 4isit was on 52th wee! of %&A

• 'oo!ing in4estigations done

F'C

%%'S Norma"

()<9

=F<

• '"ood group A>

• No omp"iations suh as b"eeding %(*febri"e i""nesses or e6essi4e pregnan$s$mptoms.

• )ating san was not done

• Was on 10 units of &nsulin aspart t,d,s



2nd rimester

•

Has started iron and calcium supp"ements

after 12t% week

•

Had fe"t ?ui!ening around 5th

wee!of %&A

• Anomaly scan at 22nd wee! @ noabnormalities deteted

• Has had tetanus to-oid but notworm treatment

• .e/eral '.. done @ higher 4a"ues



#rd rimester

• 2nd *.. san was done at 2,th wee! @ no

abnormalities deteted. 3rowth was ade?uate.• At #5 wee!s @ admitted to NFH with "ower

abdomina" pain and for b"ood sugar ontro"

• I6 @ 5/th u" 58th u"$+bfast- 58th +"unh-

• %%'S #0 mgBd" 2;5 mgBd" 22; mgBd"

+brea!fast-

• =F< @ NA)

• '. 166 mgdl +8;500mgBd"-

• SH @ 2.05 I=Bm" +0.#;./0 I=Bm"-

• # @ 2.0 pgBm"+2.#., pgBm"-

• ; @ 0./;ngBd" +0.5./; ngBm"-



#anaged wit%

I1 )e6amethasone / mg b.d 52 hour"$@ ;

doses

Nifedipine S< 20 mg b.d

h$ro6ine @ 8 mgBdai"$

)urrently s%e is on

• Insu"in aspart 2 = +mane-

2 = +da$- 2; = +note-

• 1etformin 00 mg t.d.s



Current"$*

• 'a! pain radiating to "ower abdomen

• No assoiated s$mptoms suh as fe4er*4omiting or headahe

• No signs of muoid 4agina" b"eeding or

dribb"ing• No urinar$ s$mptoms +d$suria*

fre?uen$-

• No onstipation

• She has been regu"ar"$ fo""owed up andher '% was norma" throughout



• %ast 1edia" Histor$

!ype 2 "# for $ years

+ypot%yroidism for 1 year

• %ast Surgia" Histor$

• A""ergi Histor$ NA)

• )rug Histor$

She is on drugs for )1

h$ro6ine 8 mgBda$

• Fami"$ Histor$

'oth her parents ha4e )1* H * d$s"ipidemia D IH)

No h$roid )iseases



.ocial +istory

Her husband is #/ $ears o"d Aountant Non smo!er and non a"oho"i

he$ "i4e with her parents

Has good fami"$ support

She stores insu"in in the refrigerator door

Administers insu"in on her own to herthigh

She is aware of h$pog"$aemi s$mptoms

Her eduationa" "e4e" is upto &B9s



E6amination

• 3enera" e6amination

• Height: 5.//m Weight: 8!g

•

'1I: 20./ !gB+mm-• Not pa"e

• No th$roid en"argement

•

No oedema



)ardio 4ascular .ystem e-amination

• P $2 b,p,m, egular r%yt%mnormal /olume

• %eriphera" pu"ses were present

• 'P 120$0 mm+g• No sars on the hest* no deformities

• Apia" beat th ICS mid "a4iu"ar "ine

•

1st and 2nd +eart sounds were audible.• No murmurs or thri""s



espiratory .ystem e-amination

•

7 16 min• rahea entra"* s$mmetria" hest

e6pansion

•

(oa" fremitus @ norma"• <esonant "ung 7e"ds

• (esiu"ar breathing heard without

an$ added sounds



Abdomina" e6amination

• Abdomen s$mmetria""$ en"arged

• 9inea nigra and striae gra4idarum present

• Hernia" ori7es intat

• SFH @ #/m* ompatib"e with %&A

• Sing"e fetus

• Cepha"i presentation. Head #Bth pa"pab"eabdomina""$

• 9ongitudina" "ie* <ight &A position

• Ade?uate "i?uor 4o"ume

• Appro6imate sie @ #.0 !g

• No Contrations fe"t



Summar$

•

A #/ $ear o"d mother of two presented with ba!pain and "ower abdomina" pain for # da$s duration at#/ wee!s of %&A.

• She is a !nown t$pe 2 )iabeti and a h$poth$roidiwho is urrent"$ on insu"in +2 units mane and noon*2; units at night with 1etformin 00mg b.d- andth$ro6in+8mirog-.

• Frist pregnan$ @ une4entfu".

• 2nd pregnan$ @ with t$pe two diabetes me""itus.Howe4er had no omp"iations

• 3enera" and s$stemi e6amination was une4entfu"

• Abdomina" e6: sing"e "i4e fetus* epha"ipresentation in "ongitudina" "ie at right &A position.Ade?uate "i?uor 4o"ume with an appro6imate sie of



1anagement

• In4estigations

=SS #/ wee!s @ no abnorma"it$'SS @ after brea!fast* "unh* dinner

=F<

• reatment

'etamethasone 52 mg 2; hour"$ +2 doses-

h$ro6ine 8 mgBdai"$

Insu"in sB 2 = +mane- 2 = +da$-

2; = +note-



han! $ouG

Diabetes Mellitus Complicated Pregnancy

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