Gestational Diabetic Mellitus risk factor definition causes treatment ~ Medical diseases and trems ,symptoms causes TREATMENT

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Gestational Diabetic Mellitus risk factor definition causes treatment

                     GESTATIONAL DIABETIC MELLITUS



     It characterised by hypo glycemia . GDM is neither Insulin dependent diabetes mellitus nor non Insulin dependent diabetes mellitus. Blood glucose level is 95 to 200 mg/dl . In overt diabetes 128 to 200 mg/dl.

RISK FACTOR

   * In previous pregnancy history of diabetes.

   * Big Size baby .

   * Cesarean  delivery .

   *  Dead fetus delivery .

   * In present delivery pregnancy polyhydramnios or gestational infection.

   * Risk of GDM present in 2nd and 3rd trimester .

   * Ideal time to assessment is 24 to 28 week of gestation 

   * For high risk mother assessment timing is 8 to 12 week of gestation .

 Investigation 

          Best assessment method is glucose tolerance test and fasting blood sugar test.

        * The disease complicated into labour and delivery.

Intervention

      *   Diet is the best method to control diabetes .{ 50% of carbohydrate  30% of protein, 20% of fat}.

      *  Exercise - Ideal exercise for pregnancy is swimming .

                        - other are walking and jogging .

      *  Oral drug are contraindicated .

      * management is done with or without insulin , only short acting insulin should be recommended .eg 180-220 mg/dl     - 1 unit 

                              220- 260 mg/dl    - 2 unit

                             >  260 mg/dl         - 3 unit

     * During labour use the principle of neutralization.

COMPLICATION

     METERNAL COMPLICATION

                 * Hypertension , preterm labour, prolong and obstructed labour , malpresentation, Polyhydramnios , Antepartum haemorrhage , Postpartum haemorrhage, Diabetic neuropathy, Retinopathy.

  FETAL COMPLICATION

                    * Macrosomia 

                    * Prematurity 

                    * Respiratory distress syndrome

                    * Birth injury 

                    * Intra uterine death

                    * still birth 

                    * Neonatal hypo glycemia 

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