Intra-partum management of women with diabetes

Management of hyperglycaemia is crucial during labour to improve outcomes both in the newborn and in the mother. This is particularly crucial in mothers with pregestational type 1 diabetes and in all mothers requiring insulin treatment during pregnancy. The use of antenatal steroids in mothers at risk of preterm delivery complicates management of hyperglycaemia in the immediate antepartum period and requires appropriate dosing adjustments of insulin therapy. Mothers are generally asked to be nil per orum during active labour. This requires appropriate fluid, glucose and insulin management in the hours leading on to the delivery of the baby. If the woman undergoes an operative delivery then patients continues to require glucose insulin infusion till patient is able to eat and drink normally. This review focuses on the management of hyperglycaemia during labour and in the immediate post partum period. A dosing schedule for women who receive steroids in the antepartum period is also discussed. The review suggests a practical glucose insulin regimen that can be followed during active labour in women who are nil orally. Lastly the review discusses immediate post partum management in these women as well.