Fetopathy is diabetic. Diabetes mellitus in pregnancy

No woman can be sure that her pregnancy will proceed without complications, especially if she suffers from any diseases. The fetal condition can be affected by various factors that can harm it. Therefore it is extremely important to monitor your health and to try to protect yourself from the influence of harmful conditions. Especially these moments concern those women who have various abnormalities in the work of the body.

Women who have a diagnosis of diabetes mellitus and who dream of having a baby should know that in this case they have a great responsibility on their shoulders, since such a disease can lead to various complications in the baby. One of them is the fetopathy of the fetus.

Features of the disease

Diabetic fetopathy is a serious fetal disease that occurs due to the presence of prediabetes or diabetes mellitus in a pregnant woman when the glucose level is above normal. For this pathology, a change in the state of the fetus and impaired functioning of the pancreas, kidneys, macro- and microvascular system is characteristic.

If in a medical history of a pregnant woman there is such a diagnosis as "fetopathy of the fetus," most often the doctor decides to perform operative delivery.

The favorable course of pregnancy in a woman with diabetes mellitus is dependent on numerous factors. They include: the type of disease, the existing complications, the drugs used to treat pathology. You can not be afraid of any harmful effects, if during the entire pregnancy the level of glycemia did not rise above the critical value.

If this disease is not compensated, the diabetes mellitus of pregnant women has the most negative impact on fetal development and gestation. Doctors usually give birth in advance to a woman in order to save her and her child's life. With such a disease, the ultrastructure of the placental barrier changes, as a result of which it ceases to function normally and delivers the fetus everything necessary. Doctors in this case often diagnose "hyperplasia of capillaries". The child in utero gains a lot of weight, but it does not develop well.

Symptoms

Diabetes mellitus during pregnancy leads to the fact that the newborn is born with the following signs of the disease:

• Large body weight (usually more than 4 kg);
• Point subcutaneous hemorrhage on the skin;
• Swelling of soft tissues and skin;
• Large belly due to highly developed subcutaneous fatty tissue;
• Short limbs;
• Reddish-blue skin tint;
• Excessive amount of raw skin lubricant;
• Broad shoulders.

Symptoms

Fetopathy of newborns is manifested as follows:

• A breathing disorder that is explained by the lack of synthesis of a specific substance in the lungs (surfactant), which helps them to break down during the first breath;
• Probable shortness of breath and even stopping breathing immediately after birth;
• Jaundice, considered a sign of a pathological change in the liver, which requires the necessary treatment;
• Neurological disorders: decreased muscle tone, suppression of the sucking reflex, alternation of decreased activity with hyperexcitability.

Causes

Fetopathy of the diabetic fetus develops due to the unfavorable course of pregnancy, during which there was uncompensated diabetes mellitus 1 and 2 types. In addition, the cause is maternal diabetes with gestational diabetes.

The excess amount of glucose in the mother's blood leads to the fact that the pancreas of the fetus begins to produce too much insulin. By acting through the mother's blood to the baby, glucose in large quantities begins to be actively consumed. However, for the full development of the fetus, a certain amount is required, so the surplus is converted to fat, and this leads to a large weight of the child.

If you do not normalize glycemia, then it can promote a strong buildup of fatty tissue of the fetus and will not allow the entire internal system of the baby's organs and tissues to develop normally.

Diagnostics

To identify abnormalities in the fetus, the doctor prescribes the following procedures:

• Ultrasound;
• Study of the fetal biophysical state;
• Dopplerometry;
• CTG;
• Assessment of biochemical markers of the fetoplacental system.

Carrying out ultrasound

The main method of determining any violations in the fetus is ultrasound. It is recommended to perform ultrasound in the following terms if diabetes mellitus is diagnosed during pregnancy:

• In the first trimester - once.
• In the second trimester - also once between 24 and 26 weeks. This is necessary in order to identify various malformations of the central nervous, osteoarticular, genitourinary and cardiovascular system, as well as digestive organs.
• In the third trimester, ultrasound can be performed two or even three times. With insulin-dependent diabetes mellitus, such a study is performed at 30-32 weeks, after which they do this once a week.

Signs of diabetic fetopathy for ultrasound in the fetus:

• Too much weight for a specific period;
• Disproportion of the body;
• Double contour of the head;
• Increased amount of water;
• Double fetal contour due to a large amount of subcutaneous fat or swelling of soft tissues;
• An area of the skull bones marked an echo-negative zone, indicating swelling.

Study of the fetal biophysical state

Such a survey can reveal a violation in the morphofunctional development of the brain, which is considered the most severe manifestation of embryopathy. To find this out, the doctor fixes breathing, heart rhythm and motor activity of the fetus for one and a half hours.

If there is a suspicion of fetopathy, then in this case the baby's dream will be short-lived, and most of the time he makes active movements. The duration of a short sleep is not more than 50 minutes, during which there is a slowing of the heart rate and a decrease in the heart rate.

Carrying out Doppler

With the help of such research follow the following indicators:

• The rate of contraction of myocardial fibers;
• Cardiac output;
• The time of expulsion of the left ventricle of the heart;
• Systolic-diastolic ratio of blood flow to the artery.

Dopplerometry is performed at 30 weeks to assess the state of the central nervous system.

Carrying out of a cardiotocography with an estimation of functional tests

This procedure allows you to estimate the heart rate at rest, during movement, with contraction of the uterus. Doctors conduct tests and during this time take several samples.

Evaluation of biochemical markers of the fetoplacental system

To diagnose fetoplacental insufficiency, urine and blood tests are taken. With this disease in the third trimester, diabetic fetopathy is manifested by a significant increase in ACE.

Treatment during pregnancy

During the entire pregnancy a woman should conduct self-monitoring of blood pressure and glycemia. If this is required, then additionally prescribe insulin therapy. In prophylactic purposes, sugar must be tested every 3 to 4 hours. The level of glycemia is corrected by glucose or insulin.

Fetopathy diabetic involves taking vitamins, adherence to a special diet and other doctor's recommendations. Food should be rich in digestible carbohydrates, and fat is recommended to reduce.

Treatment during childbirth

First, using ultrasound determine the optimal date of delivery. If the pregnancy is uncomplicated, it is best to give birth to a woman at 37 weeks. If there is a threat to the life of the mother and child, then they do so in 36 weeks. Medical abortion at earlier periods is usually carried out only in the event that there is an immediate threat to the life of the mother, and about saving the child speech is no longer coming.

During labor, doctors are required to monitor glycemia. With a strong lowering of the blood sugar level, the woman will not have enough strength during the fights, as much glucose is used to contract the uterus. In the course of childbirth, or immediately afterwards, there is a risk that the patient will fall into a hypoglycemic coma.

Diabetes mellitus of pregnant women provides for short delivery. If they last more than 10 hours, in this case, a cesarean section is performed, after which antibiotic treatment is prescribed.

Treatment after childbirth

To prevent the development of hypoglycemia and further complications, after a while after birth, a 5% solution of glucose is injected into the baby . Every 2 hours, it is necessary to give the newborn a mother's milk, since this nutritive liquid is able to stop this condition.

The early neonatal period should proceed under the supervision of doctors who are obliged to monitor the breathing of the child. In his absence, connect the device for artificial ventilation. In the presence of neurological disorders, calcium and magnesium solutions help. If the child has signs of liver disease, when the eye proteins and the child's skin acquire an icteric color, the doctor prescribes ultraviolet irradiation sessions at a strictly defined dose.

After giving birth, the woman reduces the insulin intake 2-3 times, because the blood glucose level drops sharply. By the time of discharge, the glycemia rate is restored to normal values.

Complications

Diabetic fetopathy of neonatal consequences can have the following:

• Neonatal hypoxia;
• A sharp drop in blood glucose levels to a critical level;
• Acute heart failure;
• Diabetes mellitus of newborns;
• The lack of magnesium and calcium, which negatively affects the functioning of the central nervous system;
• obesity.

Conclusion

Fetopathy is diabetic, which develops in the fetus with the diabetes present in the mother, a very unpleasant and dangerous disease. A woman must during pregnancy comply with all the recommendations of a doctor and keep under control the level of glucose in the blood. Only in this case the consequences for the child will not be too deplorable.