Keberhasilan Penanganan DM Pragestasional dengan Komplikasi Berat
ABSTRACT: Pregestational
diabetes mellitus is one of the most frequent medical complications in
pregnancy. Compared with gestational diabetes, there are and organs complications,
easiness to get the complications and more difficulties in glucose regulation .
Team work, intensive monitoring and adequate facilities needed to manage this
case appropriately. Here we present two cases of pregestational diabetes with
severe end organ complications i.e. retinopathy, nephropathy and chronic
hypertension. Even in literature study stated that there are infertility in
women with diabetes but only 1 case with difficulty to get pregnant. From
laboratory examination, the glucose levels were 210–220 mg/dl and Hb A1C 8% and
7,5% – a little bit higher. Maintaining appropriate blood glucose level,
managing the complications and decided the timely delivery of the baby were the
main problems. Diet, and some insulin combinations were used accordingly.
Termination of the pregnancy were done with maternal indications severe
preeclampsia; cesarean delivery were performed, 1 suffered from IUGR and 1
suffered from DKA. Intensive care by 1 team delivered to the mother and newborn
and both cases discharged in good conditions.
After two years the mothers were still under controlled and there were
no signs of obesity and DM in the babies. Lesson learned from this report is
team approach in pregestational diabetes with severe complications is mandatory
due to the difficulties in maintaining the appropriate blood glucose level and
decided the timely delivery of the baby. And monitoring the adult consequences
of fetal programming should be done closely. As with Barker hypothesis,
monitoring of both babies would be continued because the probability of
metabolic disorder in these two cases were very high.
Penulis: Ariefandi, Hermanto
Kode Jurnal: jpkedokterandd080006
