ABSTRACT
Perinatal deaths among diabetic women are sufficiently common that nearly all diabetes educators eventually care for someone who loses a baby. This case report and discussion identifies ways in which diabetes educators can promote patients' health and provide emotional first aid in the immediate aftermath of perinatal loss. Psychological reactions of both the mother and the health care providers are considered. Practical ways to assist patients, and pitfalls to avoid, also are presented.
Subject(s)
Diabetes Mellitus, Type 2/complications , Fetal Death , Pregnancy in Diabetics , Adult , Counseling , Crisis Intervention , Diabetes Mellitus, Type 2/psychology , Female , Grief , Guilt , Humans , Infant, Newborn , Male , Patient Education as Topic , Pregnancy , Pregnancy in Diabetics/psychologyABSTRACT
Diabetic ketoacidosis (DKA) is a form of decompensated diabetes. When it occurs during pregnancy, it may lead to maternal and fetal morbidity and mortality. DKA is defined by accelerated gluconeogenesis and ketogenesis and occurs most often in the presence of one of four predisposing factors: insulin deficiency (absolute or relative); excess counter regulatory hormones; fasting; and dehydration. Infection is a common catalyst. Once the disorder is diagnosed, intensive obstetrical nursing care is required. The principles of management include rehydration, insulin therapy, electrolyte replacement, and identification and treatment of the underlying cause. A plan for assessment of the pregnant patient with diabetes and in DKA and treatment guidelines are presented.
Subject(s)
Critical Care/methods , Diabetic Ketoacidosis/nursing , Pregnancy Complications/nursing , Diabetic Ketoacidosis/therapy , Female , Humans , Patient Care Planning , Pregnancy , Pregnancy Complications/therapyABSTRACT
This report complements the previously described preliminary clinical evaluation of the dehydroepiandrosterone (DHEA) loading test (DLT) by presenting the results of 65 DLTs in 59 patients. In patients whose fetuses were suspected of being intrauterine growth retarded, a DHEA to estrogen conversion rate constant less than or equal to 3.0 x 10(-3) min(-1) was associated with a birth weight below the tenth percentile in 60% of the pregnancies, whereas a conversion rate constant above this threshold was not associated with the same degree of growth retardation. The DLT continues to qualify as an accurate predictor of pregnancy outcome as judged by birth weight. Although it seems to be too cumbersome to serve as a screening technique, the DLT will permit evaluation of the efficacy of various pregnancy interventions directed toward improvement of the intrauterine environment, such as bed rest, tocolysis, or antihypertensive medication.
