A simplified management of diabetic pregnant woman

OBJECTIVE: To evaluate a simplified management of diabetic pregnant women.

METHODS: A prospective study of the management of all diabetic pregnant women (74) during 2 years from March 1995 - March 1997 was carried out in the Department of Obstetrics & Gynecology, Wad Medani Teaching Hospital, Sudan. Diabetes was diagnosed by an oral glucose tolerance test according to the World Health Organization criteria. Patients were controlled by insulin and monitored by urine for glucose and pre-prandial blood sugar. They were delivered by induction of labor or cesarean section at 38 weeks. Basic resuscitation was carried out for all babies. Intravenous glucose was given to babies when hypoglycemia was diagnosed. Early breast feeding was the rule. Babies who developed complications were managed at the special care unit in the Children's Hospital.

RESULTS: Seventy one patients completed the management, 2 ended in abortion and 69 proceeded to 30 weeks or more. There was one maternal death and 14 perinatal deaths. The main causes of perinatal deaths - Wigglesworth classification - were macerated stillbirth (5), congenital malformation (4) and intrapartum asphyxia (5). A reasonable control of diabetes (pre-prandial 179 or less) was achieved in 56 patients (79%). Seventy percent of the patients were delivered by cesarean section and the main indications were big baby (16 cases) and a previous cesarean section (20 cases). Fifty four percent of all the patients had a history of perinatal death, 28% had a history of repeated abortions and there was a definite family history of diabetes in 53%. Sixty nine percent of the patients were at the age 30 years or more and 50% of them were of the parity 5 or more.

CONCLUSION: This simplified management of diabetic pregnant women is satisfactory and feasible under our present circumstances. It is hoped that improvement in ante-natal care, delivery care and control of diabetes around the time of conception and care of the newborn will reduce the perinatal mortality rate.