Sampathkumari, S (2006) Perinatal Mortality and Morbidity in Diabetes Mellitus Complicating Pregnancy. Masters thesis, Madras Medical College, Chennai.
|
Text
200200106sampathkumari.pdf Download (293kB) | Preview |
Abstract
INTRODUCTION: “ In every child who is born under no matter what circumstances and of no matter what parents, the potentiality of human race is born again, and in him too, once more and each of us our terrific responsibility towards human life” James Agee. Gestational Diabetes mellitus and other categories of glucose intolerance during pregnancy are one of the causes for increased perinatal mortality. But nowadays with pre conceptional counselling, early screening and advances in management of diabetic pregnancy have reflected in the continuous reduction mortality and morbidity in the infants of diabetic mothers. Hypoglycemia, hyperbilirubinemia are managed with little difficulty. Respiratory Distress Syndrome and Macrosomia are now largely preventable with good glycemic control. The unresolved problem at present is the prevention of malformation in diabetic pregnancy. With the above in mind the perinatal outcome at Institute of Obstetrics and Gynaecology, attached to Madras Medical College, Chennai was analysed for possible clues in effective management of diabetic mothers who turn up at the institute. AIMS AND OBJECTIVES: 1. To know the incidence of DM complicating pregnancy in Women & Children Hospital, Institute of Obstetrics and Gynaecology, attached to Madras Medical College, Chennai. 2. To know the Perinatal Mortality and Morbidity in DM complicating pregnancy. 3. To know the maternal outcome in DM complicating pregnancy. 4. To compare the mortality with GDM and known Diabetes preceding pregnancy. MATERIALS AND METHODS: This present prospective study has been conducted at the Institute of Obstetrics and Gynaecology, Women and Children Hospital, Egmore, attached to Madras Medical College, Chennai during August 2004 to July 2005. All cases delivered in labour ward were taken in to consideration. Both Gestational Diabetes and Diabetes preceding pregnancy were included. Patients in all age groups, parity and presentation with confirmed increased sugar value were included along with associated maternal complication cases. METHODS: All patients with h/o Diabetes complicating pregnancy were assessed with:- I. Thorough history regarding: 1. Routine – for age and socio economic status, 2. Obstetric history – parity, previous Obstetric history, 3. Positive family h/o Diabetes, 4. H/o still birth, weight of previous babies, 5. H/o any congenital anomaly or unexplained death, 6. When was the disease detected – period of detection, 7. H/o diabetes in previous pregnancy and, 8. Type of treatment taken/ given. II. Clinical Examination regarding: 1. Nutritional status / Anemia/ Obesity, 2. Vital signs, 3. Abdominal Examination regarding GA, Hydramnios, Contraction, weight of babies, foetal presentation and foetal well being, 4. Vaginal examination wherever needed to assess the mode of delivery. III. Laboratory Investigation: Ultra Sonogram, Hb, PCV, Fasting blood sugar on the day of delivery, Monitoring fasting and post prandial sugar level, Glycemic profile, Post op/ Postnatal blood sugar, Routine blood sugar, bilirubin, calcium, electrolytes for all babies, X-ray chest, ECG & Echo for all babies. All patients were admitted for observation and delivery – term and nearing term. Mode of delivery either by vaginal or abdominal route was decided upon information such as history, size of baby, associated factors, glycemic control, foetal condition in uterus and maternal complication apart from the age and weight of the babies. Patients selected for vaginal delivery were watched vigilantly in all the 3 stages of labour, carefully monitored to detect the foetal distress at the earliest. In cases where the abdominal route was decided some were elective / emergency depending on previous history, associated factors, infatibility status, bad obstetric history with weight of baby, glycemic control, fasting blood sugar were analysed. Corticosteroids were administered for pre term and Diabetologists’ opinions were sought and obtained regularly. The relationship between perinatal outcome and complication in labour was documented and babies were admitted in neonatal units for care and further investigation. Foetal variables that influence the morbidity and mortality were asphyxia, malformations, RDS, Sepsis, Hypoglycemia, Hyperbilirubinaemia, Hypercalcimia, Macrosomia, Polycythemia and Cardiac Evaluation. Postnatal blood sugar for mother was ascertained and insulin was stopped almost in 90% of cases and the cases were followed up in Diabetogy OP and Postnatal OP after 6 weeks. CONCLUSION: Despite the changing trends in obstetrics, it is mandatory to have an uptodate knowledge, diagnosis, appropriate decision and management in labour. A careful intervention will avoid long-term complications; help reduce perinatal mortality and late sequalae. The Perinatal Mortality Rate of Diabetes Mellitus Complicating Pregnancy is more or less equal to normal babies. Perinatal outcome, which is little higher in DM preceding pregnancy, can be overcome by pre conceptional counselling and good glycemic control. Pre conceptional glycemic control and control around the critical period of organogenesis (7th – 8th week) though done at present needs to be carried out vigorously and effectively so as to help in lowering the incidence of congenital malformation. The incidence of caesarian section can be reduced in Diabetes Mellitus complicating pregnancy to an extent by carefully monitoring the glycemic control, which in turn will lower the macrosomia rate, and by minimizing primary section. Thus with the use of frequent home glucose monitoring, diet, insulin and team approach it is possible to achieve euglycemia in most diabetic pregnancies and prevent much of the perinatal mortality and morbidity.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Perinatal Mortality ; Morbidity ; Diabetes Mellitus ; Complicating Pregnancy. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 03 Dec 2017 06:42 |
| Last Modified: | 05 Dec 2017 00:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4154 |
Actions (login required)
 |
View Item |
