Gestational diabetes mellitus with Polyhydramnios
A 29 yr old unbooked case G 2 P1 L 1 Mrs , w/o , resident of eluru,
belonging to low socioeconomic status with regular cycles, with 8 months of
gestational age was admitted in view of increased blood sugars & increased
liquor
LMP on
EDD falls on
Period of gestation – 32weeks 2 days
H/O present illness
She was diagnosed as gestational diabetes 2 weeks back with altered
GTT values done outside and was advised diet regulation
No H/O burning Or increased frequency of micturition
No H/O itching of vulva.
No H/O bleeding or leaking P/ V.
No H/O headache, epigastric pain, blurring of vision, pedal edema.
Obstetric history: G2 P1 L1
1st pregnancy : conceived spontaneously with in a year of marital life.
Antenatal period ;
Delivered a single full term male child of birth weight 3.0kg at private
hospital through normal delivery. labour & puerperium were
normal.breast fed for 1 year.baby is Immunized and healthy.
2nd Pregnancy (present pregnancy) : Conceived spontaneously 4yrs after last
child birth. No H/O Using Contraception.
Confirmed by UPT at private clinic at 2months of gestational age
First Trimester:
No H/o nausea/ vomiting.
No H/o Burning / increased frequency of micturition.
No H/o Spotting / Bleeding PV.
No H/o Fever with rash.
No H/o Radiation exposure.
Dating scan was done.
Took folic acid supplementation
Second Trimester :
Quickening felt in late 5th month of gestation.
She took 2 doses of TT at 4th and 5th month of gestation.
No H/o Burning / increased frequency of micturition.
No H/o blurring vision / headache / epigastric pain.
No H/o leaking PV / bleeding PV.
Anomaly scan was done and normal.
Took Iron folic acid and Calcium supplementation
Third Trimester :
Continued perceiving fetal movements well.
No H/O blurring vision / headache / epigastric pain/ Pedal edema.
No H/O burning / increased frequency of micturition
No H/O bleeding PV/leaking P/V
Routine antenatal scan was done and said to be normal.
Continued taking Iron and Calcium supplementation
Menstural H/O :Age of Menarche – 14 years
She has regular cycles, bleeds for 3 - 5 days for every 28 – 30 days, not
associated with clots, no pain abdomen
Marital H/O: ML– 5 years; Non consanguinous; No H/o usage of any OCPs
Past H/O:
No H/O HTN / DM / B.Asthma / TB / Epilepsy/ Thyroid / Cardiac / Renal
diseases
No H/O previous surgeries / blood transfusions.
Family H/o:
No H/O HTN / DM / B.Asthma / TB / Epilepsy / Thyroid / Cardiac / Renal
diseases .
No H/O Twins / MR child / Congenital abnormalities.
Personal H/o:
Mixed diet
Bowel & bladder – regular. Sleep & appetite – regular.
No H/o drug / food allergies / Addictions
DIET HISTORY :
▪ 8AM: 4 idly (200 cal/ 8g) + sambar (300cal / 10g) What’s
▪ 10AM: 1 fruit (104cal/0.6g) this gm ?
▪ 1PM: 1 cup rice (100cal/2g)+ vegetables (60cal/ 1g) +
curd (67cal/3.3g) + curry dal (300cal/10g)
▪ 4.30PM: 4 biscuits (100cal/2g)+ 1 cup of tea (60cal/1.4g)
▪ 7PM: 2 Poori (480cal/ 12.2g)+ potato curry (132 cal/ 3.2g)
▪ 10PM: 1 cup of milk (67cal / 3.3g)
▪ Total calorie intake – 1970cal (1935 cal)
▪ Total protein intake – 57g (64.5g)
GENERAL EXAMINATION
No Pallor/ icterus/cyanosis/lymphadenopathy/ pedal edema
Thyroid, Breasts & spine- normal.
Lower palpebral conjunctiva and tongue appeared normal
Nails, hair, oral mucosa, palate and gums and skin were normal teeth ?
Pre-pregnancy weight- 60 kg, Height- 152cm,pre pregnancy BMI:-26kg/m2
Current weight- 68.5kg
Vital data:
Temperature- 98.60 F
Pulse rate- 90/minute, regular
BP- 100/70 mmHg
Respiratory rate- 20/min
Systemic examination:
CVS- S1, S2 heard. No murmurs
RS- Normal vesicular breath sounds, no added sounds
Obstetric examination :
Inspection :
Abdomen is globular in shape
Umbilicus midline and everted
Linea nigra and stria gravidarum seen
No scars / sinuses / engorged veins
Hernial orifices appears normal.
Palpation – 36 weeks overdistended
Height of uterus- term gestation (> period of gestation)
SFH:-36 cms Abdominal Girth -100 cms
On Fundal grip - soft, non-ballotable fetal pole felt, probably breech
On Lateral grip-uniformly curved resistance felt on left side suggestive of fetal
spine. Irregular knob like structures felt on right side suggestive of fetal limbs.
On 1st Pelvic grip –hard , round, ballotable structure felt suggestive of head.
On 2nd Pelvic grip – hands are converging suggesting that it is not engaged
Clinically liquor appears more than normal.
EFW - ?
Auscultation :
FHS heard below the umbilicus on the left side @ 148/ min, regular in rhythm
Summary:
A 29yr old G2P1L1 with 34 weeks Gestation with altered GTT reports with
polyhydramnios with gestational diabetes complicating pregnancy. She is on
diabetic diet since 4 weeks.
