Resolution of severe fetal distress following treatment of maternal diabetic ketoacidosis

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.

Figure 1

Cardiotocograph shows poor variability and persistent unprovoked decelerations.

Figure 2

Cardiotocograph shows a baseline of 160 beats per minute and improved variability.

Figure 3

Cardiotocograph shows a baseline of 170 beats per minute, improved variability and occasional decelerations with recovery to baseline.

Figure 4

Cardiotocograph shows a baseline of 150 beats per minute and normal variability.

Figure 5

Cardiotocograph shows a baseline 130 beats per minute, normal variability and accelerations.