| Appointment | Care for Women with Diabetes during Pregnancy |
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| First appointment (ideally by 10 weeks) | Information, advice, and support given in relation to optimising glycaemic control. Information and advice given about how diabetes will affect the pregnancy, birth, and early parenting.\nThe extent of diabetes-related complications including renal function* will be established and medications will be reviewed and changed if needed.\nRetinal screening will be arranged (if has not recently been done)**.\nWomen will be advised about the schedule of ultrasound scans The next scan should be booked at each scan appointment. |
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| Approx 16 weeks | Retinal assessment** |
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| 20 weeks | Detailed scan which includes four-chamber view of the fetal heart and outflow tracts. |
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| 24 weeks | Ultrasound scan to monitor fetal growth and amniotic fluid volume (LV). |
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| 28 weeks | Ultrasound scan to monitor fetal growth and amniotic fluid volume (LV).\nRetinal assessment** |
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| 32 weeks | Ultrasound scan to monitor fetal growth and LV. |
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| 36 weeks | Ultrasound scan to monitor fetal growth and LV Information and advice given about:
• Timing, mode, and management of birth. Induction of labour information sheets given to women to take away and read.
• Changes to blood glucose lowering therapy during and after birth.
• Care of the baby after birth.
• Initiation of breastfeeding and the effect of breastfeeding on glycaemic control.
• Contraception and follow-up. |
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| 37+0 weeks to 38+6 weeks | Offer induction of labour / caesarean section. If patient chooses to await spontaneous labour, then advised to monitor Fetal movements (FM) on a daily basis and to report any decrease. |
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| 39 weeks | Advise induction of labour / caesarean section. If declined, review by senior obstetrician for individualised care plan. |
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| *If serum creatinine is abnormal or if urine protein creatinine ratio (UPCR) exceeds 30mg/mmol, referral to a nephrologist should be considered. Thromboprophylaxis should be considered for women with significant proteinuria.\n **If significant retinopathy found then monthly retinal assessments will be organised ± /-referral to ophthalmology. |