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Management of High-Risk Diabetic Pregnancy with Polyhydramnios

30-year-old known diabetic, G6P3A2, presented at 28 weeks gestation with polyhydramnios and unstable blood sugar levels. The patient was counseled on the risks associated with diabetes in pregnancy and advised on maternal and fetal surveillance, insulin regimen, diet, exercise, and medication. Delivery is planned at 38 weeks by elective caesarean section due to the high-risk nature of the pregnancy. Steroid prophylaxis will be considered post-32 weeks. Fetal surveillance includes monitoring FHR, kick counts, CTG, and regular ultrasounds.

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Management of High-Risk Diabetic Pregnancy with Polyhydramnios

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  1. BY DR.AYESHA QAMAR PGR GYNAE AND OBS UNIT 2 SZH RYK

  2. Case summary  30 year known diabetic G6P3A2 previous 2 c/sections with 1 alive issue at gestational amenorrhea of 28 week and 4 days with polyhydramnios and derrange blood sugar levels

  3. MANAGEMENT  COUNSELLED regarding  Diagnosis of established diabetes.  High risk pregnancy  Fetomaternal risks  Hypoglycemia to mother  Hyperglycemia  Preterm labour  Placental abruption  Fetal macrosomia  Anomalies  Sudden IUD

  4.  Our plan of management is  To keep pt. admitted till time of delivery  Manage this case in collaboration with  Physician  nutritionist

  5. MANAGMENT  MATERNAL SURVEILLANCE  FETAL SURVEILLANCE

  6. MATERNAL SURVEILLANCE  counselled regarding  Diet  Low glycemic index and high fibre diet  Avoid sweets and cola drinks  3 main meal and 3 snacks / day  Calculated total calories/day acc to BMI=1700Kcal/day  Exercise  30 minutes walk after meal

  7.  BSR 6 LEVELS  Fasting  2 hours post breakfast  Prelunch  2 hours post lunch  Pre dinner  2 hours post dinner  INSULIN basal bolus regimen as advised by physician  Regular insuline 30 units TDS  NPH 8 units at 11 pm  Tab glucophage 500 mg TDS

  8.  Fundoscopy  No signs of diabetic retinopathy

  9.  ECG cardiac evaluation  No signs of old MI

  10.  No signs of diabetic nephropathy  BUN=8mg/dl  S.creatinin=0.6mg/dl

  11.  Anomlysan  No gross fetal anomly  AFI 32  Single alive I/U pregnancy of about 29 weeks

  12.  We will plan her Steroid prophylaxis after 32 weeks after control of bsr levels.During steroid prophylaxis  Bsr 4 hourly  Insulin acc to sliding scale along with basal bolus regimen

  13. FETAL SURVEILLANCE  Moniter FHR every 4 hourly  Fetal kick count chart  CTG after 32 weeks  USG every 2- 4 weekly to moniter  Growth  AFI

  14. Time and mode of delivery  As this the case of high risk pregnancy (established diabetes+moderate poyhydramnios) with previous 2 c/sections and BOH and pt is on insuline regimen we will plan her delivery at  38 weeks by elective c/section after discussion with couple in the presence pediatrician.

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