Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis

BMJ Case Rep. 2018 Mar 9:2018:bcr2017221325. doi: 10.1136/bcr-2017-221325.

Abstract

Diabetic ketoacidosis (DKA) during pregnancy is a serious metabolic complication of diabetes with high mortality and morbidity if not detected and treated immediately. We report a case of a woman with type 1 diabetes mellitus who had poorly controlled diabetes in the first half of pregnancy and developed DKA at 29 weeks gestation. At presentation, she had a pathological fetal heart tracing but delivery was delayed for maternal stabilisation and reversal of acidosis. Once hyperglycaemia, acidosis and maternal stabilisation were achieved, fetal compromise resolved and delivery was no longer indicated. The patient was subsequently discharged home. She delivered vaginally a 2400 g baby at 34 weeks gestation after presenting with spontaneous rupture of membranes.

Keywords: diabetes; obstetrics, gynaecology and fertility.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Cardiotocography / instrumentation
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetic Ketoacidosis / therapy*
  • Diagnosis, Differential
  • Female
  • Fetal Distress / etiology*
  • Fetal Heart / physiopathology*
  • Fetus
  • Glycated Hemoglobin / metabolism
  • Humans
  • Pregnancy
  • Pregnancy Complications
  • Treatment Outcome

Substances

  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human