Presentation
Matevosyan NR. Management of Leaking Amniotic Fluid and Fetal Distress at 29 weeks of Pregnancy with Type-one Diabetes Mellitus. A Case Report
Salzburg-Cornell Seminars (November 1-7, 1998), Open Medical Institute
(1998)
Abstract
Gravida-one, para- null, age 26, with history of type-one diabetes mellitus, presented at the 29th week of singleton pregnancy with growing fetus, hypertonic and non-contractile uterus, and normal amniotic fluid index (AFI =9). The initial CTG showed baseline FHR 100 bmp, increased variability, sinusoidal patterns with early decelerations and one episode of late decelaration for more than 3min. Fetal crown-rump length (CRL), biparietal diameter (BPD), femur length (FL), head circumference (HC), occipitofrontal diameter (OFD), abdominal circumference (AC), and humerus length (HL) matched the gestation age. Placenta was sonographically uneventful, at the posterior midline location. Maternal fasting blood sugar level was 131 md/dL. Either form of anemia was absent. The clotting profile showed increased plasma fibrinogen (395 mg/dL) and decreased antithrombin III (77%) - beyond the gestational physiological margins. There was slight leucocytosis with left shift. CRP was 2.9 mg/L. Vaginal histology revealed fetal squamous epithelia. The amniotic swab test was positive. The standard protocol for treatment of fetal distress and the increasing risk of premature labor at the 29th week of pregnancy is surfactant and cortisol therapy for the fetal lung preparation and prevention of the chorioamnionitis. However, administering cortisol to a woman with type-one diabetes would constitute a medical negligence. The case was managed by surfactant and insulin therapy with intensive potassium monitor and oral intake of zinc-sulfate (ZnSO4). Tocolysis was achieved by IV magnesium therapy which was also beneficial for the diabetes. The patient went into labor at the 33rd week of pregnancy, with newborn weighing 2115 grams and height of 43 cm . Apgar scores were 7 and 8 at minutes 1 and 5, afterbirth. Placental histology did not find chorioamnionitis. Ketoacidosis and dehydration were absent postpartum.
Keywords
- Diabetes,
- Gestational Diabetes,
- Ketoacidosis,
- Surfactant,
- Premature birth
Disciplines
Publication Date
Fall November 1, 1998
Location
Salzburg, Austria
Citation Information
Naira R. Matevosyan. "Matevosyan NR. Management of Leaking Amniotic Fluid and Fetal Distress at 29 weeks of Pregnancy with Type-one Diabetes Mellitus. A Case Report" Salzburg-Cornell Seminars (November 1-7, 1998), Open Medical Institute (1998) Available at: http://works.bepress.com/naira_matevosyan/94/