Gestational diabetes mellitus
- Neethu Ravi
4th year MBBS
ESIC medical College ,Bangalore
• Name : Mrs. ABC
• Age: 30 years
• Address:Ramnagar
• Educational status : 10th grade
• Occupation: Tailor
• Husband’s name: Xyz age : 34 years ; education:2 nd PUC ;occupation : Electrician
• Socioeconomic status : Lower middle class
• Obstetric score: G2P1L1A0
• LMP : 13/12/19
• EDD: 20/09/20
• Gestational age : 37 weeks
• Blood group: O positive
• Date of admission:26/08/20
• Date of examination:28/08/20
Chief complaints: The lady comes with 8 and half months of amenorrhea
and was admitted from antenatal clinic in view of high blood sugar levels
History of presenting illness:
• Patient came for her regular antenatal check up and was found to have
high blood sugars hence admitted
• No h/o increased hunger , thrist or frequency of micturition
• No history suggestive of recurrent urinary tract infection . No history of
vaginal discharge
• No h/o skin infections
History of present pregnancy
1st trimester
It is a booked case
• spontaneous conception diagnosed by urine pregnancy test in the local hospital done at
1 .5months after missed period
• Confirmed by dating scan done at 1.5 months
• Folic acid tablets taken
• No h/o excessive vomiting , fever with rashes
• No h/o bleeding pv or discharge pv
• No h/o pain abdomen
• No h/o burning micturition , increased frequency of micturition
• No h/o radiation exposure or drug intake
2nd trimester
• Quickening was felt at 5th month
• 2 doses of tetanus toxoid taken at 3rd and 5th month
• Iron and folic acid tablets ; calcium tablets taken regularly
• Anomaly scan was done at 5th month and the report was normal
• No history suggestive of increased thrist or increased frequency of
micturition
• No h/o pedal edema /blurring of vision/ headache/epigastric pain
/decreased urine output
• No h/o bleeding pv or leaking pv
3rd trimester
• Continued to perceive the fetal movements well
• Growth scan was done at 7th month and the report was normal
• No h/o blurring of vision/ headache/epigastric pain /decreased
urine output / swelling of feet
• No h/o bleeding or leaking pv
Patient visited antenatal clinic at 8 .5 months of amenorrhea and
was found to have increased blood sugars so she was admitted
Total weight gain =10kgs
Regular antenatal visits
Menstrual history
• Age of attainment of menarche: 14 years
• Past cycles were Regular , 28-30 days cycle with 3-4 days flow
• She changes 2-3 pads per day
• Not associated with dysmenorrhoea or passage of clots
Obstetric history
Married life of 6 years , non consanguineous
Obstetric score :G2P1L1A0
G1- 4 years ago , booked pregnancy at district hospital,had a normal vaginal
delivery , female child of birth weight 2.8kgs with no NICU admission
• Baby cried immediately after delivery
• Breast feeding was started within half an hour of delivery, no prelactal feeds were
given
• There were no antenatal or postnatal complications of this pregnancy
• The child is immunized till date
• Child is alive and healthy without any delay in developmental milestones
• Copper T Intrauterine device was inserted soon after the birth of first child and
was removed after 3 years
Past history
• No h/o Diabetes mellitus, hypertension, asthma, TB , thyroid illness,
epilepsy
• No h/o surgery or medical interventions
• No h/o blood transfusion
Family history
• Her mother is diabetic from past 3 years
• No h/o children with Congenital malformations
• No h/o twinning in the family
• No h/o Hypertension, asthma, TB in other family members
Personal history
• Diet:Mixed
. *Morning : 5idli and 1 cup sambar
one cup coffee
*Afternoon : 3 cups rice and 2 cups sambar
*Evening: 1apple and 1 cup milk
*Night : 3cups rice and 2 cups sambar
Calories required =2,500 kcals
Calories intake = 2,100kcals
Calorie Deficit = 18%
• Appetite : Good
• Sleep : sound and adequate
• Bowel and bladder : regular
• no h/o any substance abuse
• No h/o any known drug allergy
General physical examination
• Patient is conscious, co-operative and well oriented to time , place and person
Vitals
• Patient is afebrile
• Pulse rate : 82 Beats/min in right radial artery which is regular in rhythm, good volume , normal in
character, no vessel wall thickening, equal on both sides , no radioradial or radiofemoral delay and
all the peripheral pulses were palpable
• Blood pressure: 120/80 mmHg in right arm in sitting position
• Respiratory rate : 16 breaths /min
• No pallor , icterus. Clubbing, cyanosis , lymphadenopathy and pedal edema
• Height : 155cms
• Weight : pre- pregnancy: 58kgs
• present weight : 68kgs
• Prepregnancy BMI : 24.14kg/m2
Head to toe examination
• orodental hygiene well maintained and no signs of nutritional
deficiencies
• No dilated veins over the neck
• Spine ,thyroid appears normal
• Breast shows normal changes of pregnancy, no retracted or cracked
nipples and no palpable lump
Systemic examination
CVS examination
S1 S2 heard , no murmurs heard
RS examination
Normal vesicular breath sounds heard
No added sounds
CNS examination
No focal neurological deficits
Per abdominal examination
Inspection
• Shape of abdomen: globular , it is uniformly distended
• Corresponding quadrants move equally with respiration
• Umbilicus is central and everted , flanks are not full
• Linea nigra and stria gravidarum is present
• No visible incisional scars , sinuses or dilated veins
• Hernials orifices are intact
Palpation
• No local rise in temperature and no tenderness
• Fundal height corresponds to 36weeks
• Abdominal girth is 98 cms at the level of umbilicus
• Symphysiofundal height is 36cms corresponds to gestational age
Leopolds manoeuvres
• Fundal grip : Broad , soft , irregular mass suggestive of breech
• Lateral grip :right – irregular multiple knob like structures suggestive of limbs
Left – continuous curvilinear resistance suggestive of spine
• 1st pelvic grip: hard ,round independently ballotable mass felt suggestive of head
• 2nd pelvic grip: Converging so head is not engaged
Auscultation
Fetal heart sounds heard in the left spinoumbilical line which is 140
beats / min
Summary
• A 30 years old lady weighing 68kgs , is G2P1L1A0 married since 6
years with no previous history of diabetes mellitus in preconception
period , with 18% of calorie deficit and positive family history for
diabetes mellitus, examination revealed fetus corresponding to
gestational age in cephalic presentation, came during her regular
antenatal check up and found to have elevated blood glucose levels
Provisional diagnosis
A 30 years old lady is G2P1L1A0 at 37 weeks of gestation in cephalic
presentation with Gestational diabetes mellitus not in labour
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