Gestational Diabetes Mellitus. Dr. Hema Divakar. Director, Divakar’s Hospital for Women, Bangalore. Secretary General, ICOG Former Vice president FOGSI Lots of publication on Diabetes in pregnancy. Gestational Diabetes Mellitus. Diagnosed first time in pregnancy May not last after.
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Divakar’s Hospital for Women, Bangalore.
Secretary General, ICOG
Former Vice president FOGSI
Lots of publication on Diabetes in pregnancy
5–10 times higher than in white women1
1.Reece EA et al.Lancet. 2009; 373: 1789–1797.
2. Sela HY et al.Expert Rev of Obstet Gynecol. 2009;4(5):547-554.
Women with diabetes have a less satisfactory pregnancy outcome compared with the general population and they have a 2.5-fold greater risk of a perinatal mortality.
Dunne F, Brydon P, Smith K, et al.Diabet Med. 2003 Sep;20(9):734-8.
de Valk HW, van Nieuwaal NH, Visser GH.Rev Diabet Stud. 2006 Fall; 3(3): 134–142
The reported incidence of macrosomia (>4000 g) in women with
GDM varies between 16% and 29%, as against to 10% rate
in women without GDM 1
1. Sela HY et al.Expert Rev of Obstet Gynecol. 2009;4(5):547-554.
Low apgar scores
Galtier-Dereure F, Boegner C, Bringer J. Am J ClinNutr. 2000;71(5 Suppl):1242S-8S.
Stagnation of induced labor
Fetal age established by CRL scan
11 – 14 wks – NT scan
Anomalies ruled out
in Targeted scan
There is no increase in birth defects in offspring of diabetic fathers
prediabetic women and women who develop gestational diabetes after the first trimester,
suggesting that glysemic control during embryogenesis is the main factor in the genesis of diabetes-associated birth defects.
-Kitzmiller/ Gavin - JAMA 1991
GDM is an entity mandating universal screening & meticulous follow-up to yield optimal outcome
Early diagnosis of gestational diabetes mellitus (GDM) is a prerequisite to reducing fetal and neonatal complications of GDM
Peripartum diabetic fathers
Failed vaginal birth after cesarean delivery
1) Anesthesia complications
2) Postpartum endometritis
3) Wound breakdown
4) Postpartum thrombophlebitis
Dr. Hema Divakar
Hon. Sec. ICOG
President KSOGA- Karnataka
So much new knowledge diabetic fathers
Dynamic event serial scans required
3% De Cherny 10% Hafer
Septum } RPL rate reduced
Aschermans } from 77.4% to 18.2%
Highlights the role of laprohysteroscopic surgery.
Many uncertainties wrt uterine anomalies diabetic fathers
Majority of women with short cervix and funneling may not have preterm labor
Pre -Embryonic loss - (less than 6 weeks) women with previous failed transvaginal cerclage.
Embryonic loss - (6 – 8 weeks)
FP + FH ?
>8 weeks FH + - APLA / Anatomic
but lost later others
Informative investigations in RPL women with previous failed transvaginal cerclage.
Non-informative investigations in RPL women with previous failed transvaginal cerclage.
Oral Depo Pessaries
6 trials meta analysis – women with previous failed transvaginal cerclage.
Exogenous Progesterone does not improve pregnancy outcome
? Lack of controlled trials
? Lack of Progesterone receptors
Micronised natural progesterone women with previous failed transvaginal cerclage.
logical support in LPD
Current concepts about implantation women with previous failed transvaginal cerclage.
Why did your mother reject you?
Improvement in Pregnancy outcome not statistically significant
-Resendus et al
- Vytiska Binstorfer
Allylestrenol – women with previous failed transvaginal cerclage.
Associated with congenital anomalies like
- club foot
Contraindicated in Pregnancy
significant reduction in
pregnancy loss RR 0.46
Chromosomal 3.5 %
Anatomical 1.6 %
Infection 0.5 %
Endocrine 20 %
Immunological 20 %
Idiopathic 43 %
50 % - no reason ! women with previous failed transvaginal cerclage.
Role of TLC & psychotherapy
Has to be taken more seriously
% women with previous failed transvaginal cerclage.
Care provided in a specialized , dedicated clinic
Some cautionary issues in the management of RPL women with previous failed transvaginal cerclage.
THANKS women with previous failed transvaginal cerclage.