Ques. 1 How can a pregnancy case be complicated due to Diabetes mellitus?
Ans. When glucose is present in urine and is in high quantity in blood during pregnancy, is said to be complicated with diabetes. Glycosuria during pregnancy is usually result of lowering of the renal threshold for glucose, but it is essential that occasional case where it is due to diabetes should be recognized and treated.
Diabetes mellitus is chronic familial disease characterized by hyperglycaemia and glycosuria. It is caused by an absolute or relative deficiency of insulin.
To differentiate both condition the following things are to be kept in mind and they are –
- When diabetes is not known to be present before the onset of the present pregnancy a history of one or more previous pregnancies associated with intra-uterine death, neonatal death of excessive birth-weight of foetus is strongly indicative that glycosuria can be diabetic in origin.
- Diabetic glycosuria is associated with typical symptoms charac-teristics of diabetes – polyuria, polyphagia, polydypsia, peripheral neuritis, pruritis valvae.
- In more than half of the cases of diabetes associated with pregnancy, the disease is known to have been present before the pregnancy began.
Abortion and intra-uterine death in the later weeks are still common, while undue size of the foetus causes its death during delivery. Hydramnios is common complication of diabetes and sugar has been found in liquor amnii in some cases. Diabetes is prone to develop pre-eclamptic toxaemia. Before insulin, in diabetes was associated with pregnancy usually the result was very fatal one for mother and child both. Now-a-days if, under insulin and diet, the diabetic women can be kept in good health. The foetal mortality still remains very high, but there has been decrease in maternal mortality rate.
Effects of Diabetes on Pregnancy :
- Congenital malformation of the fetus.
- Increased perinatal mortality.
- Maternal mortality.
- Abortion – risk increases where there is vascular involvement.
- Monilial vulvo-vaginitis.
Ques. 2 What are the effects of Diabetogenic pregnancy?
Ans. Effects of Pregnancy on Diabetes (pregnancy is diabetogenic) : -
- More chance of ketosis.
- Aggravation of retinitis and other vascular changes.
- Following delivery insulin sensitivity increases, hence does is to be reduced.
- Increase in insulin requirement esp. in the third trimester.
Ques. 3 How can a case of diabetogenic pregnancy be managed?
Ans. MANAGEMENT – If patient is a primigravida with severe diabetes of a multipara with history of previous still-births, caesarean section should be carried out at about the 36th week of pregnancy. In other cases a surgical induction of labour may be attempted. Reason for carrying out the caesarean section is merely to avoid intra-uterine death of foetus, but the child has only a precarious hold on life and pediatrician is required to tide it over the first few days of life. The patient must be seen frequently throughout her pregnancy and it is better if physician and the obstetrician should co-operative with each other in treating her to improve bad results for foetus. The patient must be admitted to hospital if the glycosuria becomes unmanageable. Onset of hypertension of hydramnios is further indication for hospital management. The diabetic foetus is liable to die in utero at any time but particularly during last four weeks. Its weight at this time may exceed that of a child born at term.