Abstract

Introduction: Diabetic ketoacidosis (DKA) is a serious metabolic complication of diabetes with high mortality if undetected. Its occurrence in pregnancy compromises both the fetus and the mother profoundly. Fortunately, the occurrence of DKA in women with diabetes who become pregnant is rare ~ 1-3%. Pregnant women are at a greater risk for DKA than are non pregnant diabetic women.

Clinical Description: We present a case of a 23 year old patient G2P1L1 with 37.2 week period of gestation, a known c/o Type 1 diabetes mellitus, referred from another hospital with sinus tachycardia. On proper examination and investigation, patient was diagnosed a case of diabetic ketoacidosis in pregnancy. Patient was admitted in high dependency unit (HDU) and was managed according to the protocol. Patient was put on continuous cardiotocography (CTG). CTG was showing fetal tachycardia with absent variability. Patient was taken up for category 1 caesarean section. Baby delivered was deeply cyanosed with no fetal heart beat. Resuscitative efforts were accomplished in the form of cardiopulmonary resuscitation, vasopressors, oxygen. Despite best efforts baby could not be revived. Arterial blood gas analysis of cord blood revealed acidosis. Post caesarean patient was shifted to HDU and discharged on day 4 in satisfactory conditions.

Discussion: A single episode of DKA poses considerable risk to the fetus. In our case CTG showed absent variability and the outcome was a fresh still birth with ABG showing acidotic fetus. Kamalakannan D (2002) also reported an adverse fetal event ~ a still birth at 36 weeks POG to a 28 year old female with type 1 Diabetes complicated with ketoacidosis. Another episode of fetal demise had been reported by Carrol MA (2005) at 31 weeks of POG to a 23 year old woman G3P2. 5% fetal mortality rate have been reported by Baagar KA (2017) in their 3 year retrospective study on analysis of diabetic ketoacidosis in pregnant women.

Conclusion: Prevention, early recognition, hospitalisation and aggressive management remain the cornerstones to minimise the outcomes of this dreaded complication.

Keywords: Cardiotocography (CTG); High Dependency Unit (HDU); Diabetic Ketoacidosis (DKA)

References

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Citation

Citation: Surya Malik and Shabbir Ahmad Sheikh. “Diabetic Ketoacidosis in Pregnancy: A Rare but Serious Threat to Mother and Fetus”. Acta Scientific Women's Health 2.2 (2020): 51-53.

Copyright

Copyright: © 2020 Surya Malik and Shabbir Ahmad Sheikh. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.