Acta Scientific Women's Health (ISSN: 2582-3205)

Case Report Volume 2 Issue 2

Diabetic Ketoacidosis in Pregnancy: A Rare but Serious Threat to Mother and Fetus

Surya Malik1* and Shabbir Ahmad Sheikh2

1Specialist, Department of Obstetrics and Gynaecology, King Khalid Hospital, Riyadh, Saudi Arabia
2Consultant, King Khalid Hospital, Riyadh, Saudi Arabia

*Corresponding Author: Surya Malik, Specialist, Department of Obstetrics and Gynaecology, King Khalid Hospital, Riyadh, Saudi Arabia.

Received: December 20, 2019; Published: January 22, 2020

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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)

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References

  1. Bedalov A and Balasubramanyam A. “Glucocorticoid –induced ketoacidosis in gestational diabetes: sequelae of acute treatment of preterm labor”. Diabetes Care 20 (1997): 922-924.
  2. Maislos M., et al. “Diabetes Ketoacidosis. A rare complication of gestational diabetes”. Diabetes Care 16 (1992): 661-662.
  3. Bernstein IM and Catalano PM. “Ketoacidosis in pregnancy associated with the parenteral administration of terbutaline and betamethasone: a case report”. Journal of Reproductive Medicine 35 (1990): 818.
  4. Kamalakannan D., et al. “Review Diabetic Ketoacidosis in Pregnancy”. Postgraduate Medical Journal 79 (2003): 454-457.
  5. Parker JA and Conway DL. “Diabetes ketoacidoisis in pregnancy”. Obstetrics and Gynecology Clinics of North America 34 (2007): 533-543.
  6. Ramin KD. “Diabetic Ketoacidosis in Pregnancy”. Obstetrics and Gynecology Clinics of North America 26.3 (1999): 481-488.
  7. Veciana MD. “Diabetes Ketoacidosis in pregnancy”. Seminars in Perinatology 37 (2013) 267-273.
  8. Kilbert JA., et al. “Ketoacidosis in diabetic pregnancy”. Diabetes Medicine 10 (1993): 278-281.
  9. Montoro MN., et al. “Outcome of pregnancy in diabetic ketoacidosis”. American Journal of Perinatology 10 (1993): 17-20.
  10. Sibai BM and Viteri OA. “Diabetic ketoacidosis in pregnancy”. Obstetrics and Gynecology 123 (2014): 167-178.
  11. Hollingsworth DR. “Medical and Obstetric complications of diabetic pregnancies: IDDM, NIDDM, and GDM”. In: Bron DL, Mitchell C, (eds): Pregnancy, Diabetes and Birth: A Management Guide, 2nd ed. Baltimore: Williams and Wilkins (1992).
  12. Chauhan SP and Perry KG. “Management of diabetic ketoacidosis in the obstetric patient”. Obstetrics and Gynecology Clinics of North America 22 (1995): 143-155. 
  13. Winkler C and Coleman F. “Endocrine emergencies”. In: Belfort M, Saade G, Foley M, Phelan J, Dildy G, (eds): Critical Care Obstetrics, 5th ed. Blackwell Publishing Ltd (2010).
  14. Rodgers BD and Rodgers DE. “Clinical variables associated with diabetic ketoacidosis during pregnancy”. Journal of Reproductive Medicine 36 (1991): 797-800.
  15. Carrol MA., et al. “Diabetic Ketoacidosis in pregnancy”. Critical Care Medicine 33 (2005): 347-353.
  16. Takahashi Y., et al. “Transient fetal blood flow redistribution induced by maternal diabetic ketoacidosis diagnosed by Doppler ultrasonography”. Prenatal Diagnosis 20 (2000): 524-525.
  17. Baagar KA., et al. “Retrospective Analysis of Diabetic Ketoacidosis in Pregnant Women over a Period of 3 Years”. Endocrinology and Metabolic Syndrome 6 (2017): 1000265.
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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): 01-03.




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