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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 2: Management, delivery, and postpartum
9. Postpartum Management
Case continued
Ms Kanulie is scheduled for induction shortly after 38 weeks. She is NPO and her usual morning insulin is not given. Her FBS is 79. An infusion of D5LR at 125 mL/hr is begun. An insulin drip with 125 units of regular insulin in 250 mL of NS (1 unit/mL) is also begun at 1 unit per hour. Fingerstick glucose is checked hourly and the insulin drip is adjusted to maintain the maternal blood sugar between 60-90 mg/dL.
Labor is induced with low dose vaginal misoprostol and is well tolerated by the fetus. After approximately 8 hours of labor, a rapid vaginal delivery of a normal appearing 8 pound 2 ounce baby girl with Apgars of 9 and 9 takes place. The baby’s first heel-stick glucose is 42 and remains above 40 when checked hourly over the next 4 hours.
Ms Kanulie’s FBS the next morning is 72 and her post- prandial sugars are also all under 120, and insulin therapy is not continued. She is discharged on the second postpartum day with recommendations for a no added-sweets diet. She is breast-feeding without difficulty, and is still undecided about family planning.
Postpartum Management
Patients with pre-gestational diabetes may experience a “honeymoon” period with euglycemia without therapy in the immediate postpartum period. By definition, gestational diabetic women should remain euglycemic without any specific therapy. It is recommended however that, especially in women like our case patient, that glucose tolerance be evaluated in the postpartum period.
The patient should be encouraged to continue the exercise and dietary habits learned during pregnancy and try to maintain her ideal body weight if possible. As noted above, a significant portion of AI/AN women who have GDM, especially if their BMI is >27, will develop frank type II diabetes as early as 5 years thereafter.
The GDM patient should receive a 75 gram OGTT at 6-8 weeks post partum and every 3 years thereafter. (see details below)
