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12 Jul 2014, Marriott Hotel & Convention Centre, Hyderabad
25 Sep 2014, CHENNAI TRADE CENTRE
What is the minimum duration for training in OB/GYN ultrasound?
FETAL SURVEILLANCE IN DIABETIC PREGNANCIES
Early scan for dating and viability
The importance of dating diabetic pregnancies cannot be overemphasised. Irregular cycles and delayed conception does happen in women with diabetes and so early scans to date pregnancies are essential. This helps monitor subsequent growth. Also as most insulin dependent diabetics will be delivered before the EDC, it is important that we have accurate dating.
Early growth lag, in women with poor glycemic control may be a marker for evolving problems.
NT and downs screening
There is no difference in the first trimester screening process and NT and FTS has to be offered to pregnant diabetics like all other women.
18 – 20 week scan with a detailed cardiac evaluation
This is absolutely essential and must be done in a standardized, systematic detailed fashion, given the increased incidence of anomalies. As some of the women with GDM / DM are obese, the timing of the scan and fetal echo may be pushed to 20 - 22 weeks for better visualisation.
These fetuses needs frequent assessment in 3rd trimester to monitor growth and fetal environment in lieu of the growth disorders and increased risk of unexplained still births.
The AC above 75th centile at 28 – 29 weeks best predicts macrosomia. Subsequent serial scans to monitor growth in poorly controlled women.
It is important to remember though that ultrasound may not detect the acute metabolic decomposition that results in still birth.
CTG and BPP are tests of fetal well being that are done weekly or twice weekly after 36 weeks in the more brittle and poorly controlled diabetics.
In uncomplicated diabetic pregnancies, doppler does not contribute significantly. It is of value when there is coexistent FGR. It helps identify pregnancies with increased placental vascular resistance and is useful in women with significant problems from diabetes such as vasculopathy.
Good glycemic control that begins pre pregnancy and is maintained through out pregnancy is the crux to managing pregnant diabetics and GDM. Ultrasound provides the means of dating the pregnancy, ruling out anomalies and monitoring the fetus and therefore plays a vital role in reducing perinatal morbidity and mortality in pregnant diabetics.