Book of Medical Disorders in Pregnancy - Tintash

of the previous day’s dose of insulin is
given at 8.00 I.V. glucose, totalling 200
Grams per day is started at 8.00 a.m. i.e.
(2000 mL 5% dextrose in water and
1000 mL of 10% dextrose in water run
for 12 hours). No analgesia or sedation is
given. After delivery, another dose of
one quarter of the previous day's insulin
is given.
Continuous electronic fetal heart monitoring
should be offered to all women
with diabetes during labor and fetal
blood sampling should be available if
indicated.
One day after delivery half of the Pre
partum insulin dose is given. A diabetic
fluid diet totalling 200 gms, carbohydrate
is offered. In the event of
nausea or vomiting, oral fluids are
stopped, and 1000 mL 10% Dextrose in
water is given.
Cesarean section:
8.00 a.m. blood glucose is done. Insulin
is withheld; narcotic premedi-cation is
withheld, I.V. Glucose totalling 200
Gms.
Per day is started at 8.00 a.m. For
example, 1500 mL of 10% dextrose in
water are run during operation, and 1500
mL of 10% Dextrose in water are run in
6 hours. Postoperatively half of the daily
dose of insulin is given. If blood is
required, it is given in a separate infusion
to avoid possible hypoglycemia.
One day after operation:
At 8.00 a.m. blood glucose is done. Half
of the predelivery dose of Lente insulin
is given. I V. Glucose totalling 200 gms
is given with 5-10 units of Semi Lente
insulin. Per flask depending on the
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morning blood glucose. On Second Post
Op. Day - the total dose of Lente and
Semilente insulin required on the
previous day is given at 8.00 a.m.
The neonate:
The newborn of the diabetic mother
should be treated as a premature infant,
irrespective of his gestational age. There
is increased incidence of respiratory
distress syndrome, congenital anomalies,
and neonatal hyperbilirubinemia, in these
babies Anomalies such as tracheo-esophageal
fistula, diaphragmatic hernia,
malrotation of the bowel, and
imperforate anus occur more frequently.
Intravenous dextrose and insulin should
be administered during labour and
delivery following an agreed multidisciplinary
protocol. The weight of the
diabetic infant is similar to that of a
nondiabetic infant up to 220 days of
gestation, but in the last 60 days of
gestation there is a significant increase in
weight. It is known that there is
hypertrophy of the islet tissue of the
pancreas in the infant of both the
established diabetic and the pre diabetic
mother there is also a direct correlation
between the amount of islet cell
hypertrophy and the fetal weight. There
is no increase in the total body water
content, but an increase in skeletal
growth does take place. It is likely that
the fetal gigantism is due to the anabolic
and lipogenic effects of fetal
hyperinsulinism and this must be
operative in the pre diabetic as well as
the diabetic phase. The four possible
reasons for fetal hyperinsulinism are
maternal hyperglycemia increase in
pituitary growth hormone, maternal
adrenal glucocorticoids and the action of
insulin antagonists. The care of these
infants should be undertaken by a
pediatrician who is familiar with the