Diabetes Mellitus: Health Significance Of Caesarian Section In Maternal Diabetes And General Prophylaxis
Cesarean Birth From A Diabetic Mother
Caesarian Section
Indications For Caesarian Section
- The cervix is not favourable for induction
- Vaginal induction has failed
- Elderly primigravida
- Usually, large sized baby
- Presence of pre-eclamptic toxemia.
After delivery, the maternal diabetes has to be controlled as in the case of a surgical diabetic. Neonatal care is more important in deciding survival of the baby and this has to be done by a neonatologist. Signs of respiratory distress syndrome, hypoglycemia and acidosis should be watched for and treated.
Diabetes Education: Proper instructions to the diabetic goes a long way in achieving the goals of therapy. The patient should be motivated to take better care of himself by developing the right attitude to the disease. The family should be taught on the dietary principles and the need to take the drugs regularly. Instruction in urine test, self injections and proper care of the feet should be undertaken. Regular visits to the physician and periodic check up are essential to maintain proper motivation and control. If properly manage, the diabetic can live a fairly normal life with some restrictions, though the disease is generally incurable.
Prevention of diabetes: This may be considered at three levels.
- Primary prevention: This refers to the prevention of the onset of the disease. This is achieved by genetic counseling, health promotion and specific counseling. Health promotion and specific protection of the prediabetic by avoiding precipitating factors.
- Secondary prevention: refers to the early diagnosis and treatment of the disease to prevent complications. At present, emphasis has definitely shifted to this stage. Proper control of diabetes serves to prevent complications.
- Tertiary prevention: This consists of limiting physical disability, resulting from the complications and institution of rehabilitation measures.
Genetic Counselling
Conditions Of parents
| Risk of developing diabetes in the offspring- Both parents diabetics 90- 100%
|
|---|---|
One parent diabetic + diabetes in grandparent and uncle or aunt
| 85%
|
One parent diabetic + diabetes in grandparent or Uncle or aunt
| 60%
|
One parent diabetic + first cousin diabetic
| 40%
|
One parent only diabetic
| 14%
|
Diabetes in first cousins only
| 9%
|
Genetic Counselling
Marriage between two diabetics is not advisable. In those with strong family history, cortisone- primed GTT can be done which may show abnormalities. Insulin levels may show abnormalities even at an earlier stage in the pre-diabetic. In such individuals, the environmental factors can be modified.
In the case of IDDM also, primary prevention is possible by identifying prople who are having the HLA types with a high risk of developing diabetes. Prevention of coxsackie B4 infections is a desirable goal in them.
© 2014 Funom Theophilus Makama
