diabetes mellitus complicated pregnancy
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7/25/2019 Diabetes Mellitus Complicated Pregnancy
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CASE 02
7/25/2019 Diabetes Mellitus Complicated Pregnancy
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• 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$sat 36wks of POA
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%ast &bs Histor$
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
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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
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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
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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$e referra"
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5st rimester
• 'oo!ing 4isit was on 52th wee! of %&A
• 'oo!ing in4estigations done
F'C
%%'S Norma"
()<9
=F<
• '"ood group A>
• No omp"iations suh as b"eeding %(*febri"e i""nesses or e6essi4e pregnan$s$mptoms.
• )ating san was not done
• Was on 10 units of &nsulin aspart t,d,s
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2nd rimester
•
Has started iron and calcium supp"ements
after 12t% week
•
Had fe"t ?ui!ening around 5th
wee!of %&A
• Anomaly scan at 22nd wee! @ noabnormalities deteted
• Has had tetanus to-oid but notworm treatment
• .e/eral '.. done @ higher 4a"ues
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#rd rimester
• 2nd *.. san was done at 2,th wee! @ no
abnormalities deteted. 3rowth was ade?uate.• At #5 wee!s @ admitted to NFH with "ower
abdomina" pain and for b"ood sugar ontro"
• I6 @ 5/th u" 58th u"$+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"-
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#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$- 2; = +note-
• 1etformin 00 mg t.d.s
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Current"$*
• '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
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• %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
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.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$mptoms
Her eduationa" "e4e" is upto &B9s
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E6amination
• 3enera" e6amination
• Height: 5.//m Weight: 8!g
•
'1I: 20./ !gB+mm-• Not pa"e
• No th$roid en"argement
•
No oedema
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)ardio 4ascular .ystem e-amination
• P $2 b,p,m, egular r%yt%mnormal /olume
• %eriphera" pu"ses were present
• 'P 120$0 mm+g• No sars on the hest* no deformities
• Apia" beat th ICS mid "a4iu"ar "ine
•
1st and 2nd +eart sounds were audible.• No murmurs or thri""s
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espiratory .ystem e-amination
•
7 16 min• rahea entra"* s$mmetria" hest
e6pansion
•
(oa" fremitus @ norma"• <esonant "ung 7e"ds
• (esiu"ar breathing heard without
an$ added sounds
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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
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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
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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-