Peripartum concerns

1. Fetal surveillance. Counting fetal movements is a simple way to assess fetal well-being. Fewer than ten fetal movements in a 12-hour period is associated with a poor outcome. Fetal surveillance should be initiated in women in whom gestational diabetes is not well-controlled, who require insulin, or have other complications of pregnancy (eg, hypertension, adverse obstetric history).

2. Early delivery. Women with good glycemic control and no other complications ideally will deliver at 39 to 40 weeks of gestation.

3. Macrosomia and cesarean delivery. The risk of macrosomia among women with untreated GDM is 17 to 29 percent. Cesarean delivery for the prevention of shoulder dystocia is recommended when the estimated fetal weight is greater than 4.5 kg.

E. Delivery. The great majority of women with gesta-tional diabetes proceed to term and have a spontaneous vaginal delivery. The maternal blood glucose concentration should be maintained between 70 and 90 mg/dL. Insulin can usually be withheld during delivery, and an infusion of normal saline is usually sufficient to maintain normoglycemia.

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