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Induction of women with gestational diabetes

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Induction of labour for Low Risk Gestational Diabetes

Up to Induction of women with gestational diabetes
March 25. 2011
Sooi-Mai Jones

Dear Jacqui,

In obstetrics the decision to induce Gestational Diabetes is the honour of the Obstetrician. Is rather individualised. In my experience, a woman who has been diet treated is placed in Midwife-led care pathway and care is provided in the community. The final review is at TERM with the Obstetrician who will make the decision for induction. Otherwise this woman has the choice of choosing to deliver in the Birth Centre.

Sooi-Mai 

March 28. 2011
Susan Cooper

The normal plan of care for our ladies with diet controlled gestational diabetes is to stop blood sugar testing around 36 weeks and treat the lady as normal - IOL at T+14 - the same as any other low risk lady.

Sue

April 18. 2011
heather chandler

Previously Susan Cooper wrote:

The normal plan of care for our ladies with diet controlled gestational diabetes is to stop blood sugar testing around 36 weeks and treat the lady as normal - IOL at T+14 - the same as any other low risk lady.

Sue

The Obstetrician at my unit will induce all women with gestational diabetes before term ,if diet managed then as close to term as possible , however if needs Metformin or insulin then from 38 weeks as with the women with Type 1 and 2.

Heather

May 05. 2011
Caroline Duncombe

Hi, In my units women with gestational diabetes are all reviewed by the obstetrician and those who are diet / metformin controlled then have shared care for the remainder of their pregnancy. As in Heather's unit, if blood glucose is well controlled by diet and growth is anticipated to be normal, IOL normally takes place at around 40 weeks. If on metformin IOL is generally between 39-40 weeks and if on insulin 38-39 weeks. It is interesting to see that in Sue's unit women who are diet controlled stop testing their BG at 36 weeks and they revert back to midwifery led care. Are there any figures from this unit to support this pattern of care because it would be a very useful tool to use if they are all good! We are currently looking at ways to reduce the CS rate which reflects on the IOL rate.

May 09. 2011
deb bett

Hi

We also recommend induction for all ladies regardless of mode of treatment however we do aim for closer to 40 weeks if they are diet controlled especially if she is a primip. I wish i had Sue's ladies, i think a lot of mine would go on a choc fest if they stopped testing at 36 weeks.

I'm finding this very useful, seeing what other units do. Perhaps for the next meeting (October) we could all fill in a form re the most common areas of contention (GTT cut offs/ use of metformin (max dose)/ timing of IOL depending on type of diabetes or method of control/ fetal monitoring at end of pregnancy/ monitoring in labour etc) and then someone could collate it all for us all to see- anonymously if necessary.

deb

May 23. 2011
Jane O'Brien

Previously deb bett wrote:

Hi

We also recommend induction for all ladies regardless of mode of treatment however we do aim for closer to 40 weeks if they are diet controlled especially if she is a primip. I wish i had Sue's ladies, i think a lot of mine would go on a choc fest if they stopped testing at 36 weeks.

I'm finding this very useful, seeing what other units do. Perhaps for the next meeting (October) we could all fill in a form re the most common areas of contention (GTT cut offs/ use of metformin (max dose)/ timing of IOL depending on type of diabetes or method of control/ fetal monitoring at end of pregnancy/ monitoring in labour etc) and then someone could collate it all for us all to see- anonymously if necessary.

deb

Hi Deb

We also do similar to you with our ladies that are diet controlled delivered at 40 weeks and those on insulin at 39-40. In my experience the women who stop testing do relax their diet which could have an effect on neonatal hypoglycaemia post delivery, however I don't have any data.

It would be great if you want to devise a questionaire and we could put it on here and ask everyone to answer it and either bring it along or send it back to yourself and then you could collate and present it at the meeting. My email address is jane.obrien@stockport.nhs.uk.  if you want to discuss it further.

Jane

June 30. 2011
deb bett
Previously Jane O'Brien wrote:

Previously deb bett wrote:

Hi

We also recommend induction for all ladies regardless of mode of treatment however we do aim for closer to 40 weeks if they are diet controlled especially if she is a primip. I wish i had Sue's ladies, i think a lot of mine would go on a choc fest if they stopped testing at 36 weeks.

I'm finding this very useful, seeing what other units do. Perhaps for the next meeting (October) we could all fill in a form re the most common areas of contention (GTT cut offs/ use of metformin (max dose)/ timing of IOL depending on type of diabetes or method of control/ fetal monitoring at end of pregnancy/ monitoring in labour etc) and then someone could collate it all for us all to see- anonymously if necessary.

deb

Hi Deb

We also do similar to you with our ladies that are diet controlled delivered at 40 weeks and those on insulin at 39-40. In my experience the women who stop testing do relax their diet which could have an effect on neonatal hypoglycaemia post delivery, however I don't have any data.

It would be great if you want to devise a questionaire and we could put it on here and ask everyone to answer it and either bring it along or send it back to yourself and then you could collate and present it at the meeting. My email address is jane.obrien@stockport.nhs.uk.  if you want to discuss it further.

Jane

Hi Jane

I'll try and put something together, let me know if there's anything you particularly want to put on the questionnaire. I'd also like to start a new forum asking about caseload of the midwives on this list (as I'm being stretched to the limit and also look after other endocrine disorders ie thyroid disease) but i can't work out how to do it ;-(
Thanks

deb

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