Peripartal management of patients and fetuses with diabetes

Peripartal period is the period just prior to delivery and soon after the delivery. During his period, patient should be prepared for the delivery. Timing of the delivery and the mode of the delivery is usually decided during this period.
Prenatal obstetric management
The goals of management of third-trimester pregnancies in women with diabetes are to prevent stillbirth and asphyxia while minimizing maternal and fetal morbidity associated with delivery.
Monitoring fetal growth is essential to select the proper timing and route of delivery. This is accomplished by frequent testing for fetal well-being and serial ultrasound examinations for trending of fetal size.

Periodic fetal biophysical testing

Various fetal biophysical tests are available to the clinician to ensure that the fetus is well oxygenated, including fetal heart rate testing, fetal movement assessment, ultrasound biophysical scoring, and fetal umbilical Doppler studies. If applied properly, most of these can be used with confidence to provide assurance of fetal well-being while awaiting fetal maturity. Initiate testing early enough to avoid significant stillbirth but not so early that a high rate of false-positive test results is encountered. In patients with poor glycemic control or significant hypertension, begin formal biophysical testing as early as 28 weeks' gestation. In patients who are at lower risk, most centers begin formal fetal testing by 34 weeks' gestation. Fetal movement counting is performed in all pregnancies from 28 weeks onward.

Assessing fetal growth

Monitoring fetal growth continues to be a challenging and imprecise process. Although the tools available now (eg, serial plotting of fetal growth parameters) are superior to those used previously for clinical estimations, accuracy is still only plus or minus 15%.
Despite problems with accuracy, ultrasound-based estimations of fetal size have become the standard of care. Estimate fetal size once or twice at least 3 weeks apart in order to establish a trend. Time the last examination to be at 36-37 weeks' gestation or as close to the planned delivery date as possible.