Diabetic pregnancy: Management of diabetes on the day of delivery
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An insulin regimen for management of the insulin dependent diabetic on the day of delivery is described. Pregnant diabetics were fasted on the day of delivery and infused with 10g glucose per hour throughout labour and after delivery until normal eating was resumed. In the morning a fixed dose of intermediate acting insulin (NPH 24 units) was administered subcutaneously at 8:00 A.M. This dose was found suitable for women whose insulin requirements during pregnancy ranged from 60 to 250 units/ day. The regimen worked satisfactorily both under close study conditions and also when used routinely and was equally applicable to the diabetic scheduled for induction or for elective Caesarian section. It was associated with an 8% incidence of foetal distress amongst women who were induced. Neonatal hypoglycaemia affected 19% of all infants, the incidence rising from less than 10% amongst infants of women with the best control to 41% amongst infants of women with the worst control. No cases of maternal hypoglycaemia during or after delivery were recorded.
Key wordsPregnant diabetics day of delivery insulin management foetal distress neonatal hypoglycaemia
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