Problems that occur during delivery
There are several problems associated with a diabetic's delivery:
- failure to progress due to foetal macrosomia
- shoulder dystocia:
- the foetal head may be delivered without problems but in a macrosomic foetus the shoulders are wider than the head and may become caught at the pelvic brim
- this is an obstetric emergency associated with a high foetal morbidity and occasional mortality
- blood glucose control during and after labour:
- care is required to avoid hypoglycaemia immediately after labour as insulin resistance falls rapidly
- the insulin dose must be reduced to about 50% of pregnant levels immediately after delivery
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