December 14, 2009

Case: DM with hydrocephalus baby


a) H(x) and P(e)

b) Investigation and management


1) Regarding DM

a) Since when? Pre existing or during this pregnancy

b) Any history of macrosomic baby, Polyhydramnios or unexplained IUD during previous pregnancy?

c) Are there family risk factor?

d) Is MOGTT done? (normally early pregnancy and repeated at24-28w in high risk group in which initial test is negative)

e) Now on diabetic diet, OHA, or insulin.

f) Ever being admitted due to DM complication like hypoglycaemia, diabetic foot.

g) Any complaint of DM complication like heart disease, peripheral vascular disease, diabetic nephropathy, diabetic retinopathy.

2) Regarding hydrocephalus

a) How did the patient know that? Through US (usually diagnosed after >24w)? Who confirmed it?

b) Did mother took/compliance to folic acid?

c) Did previous baby having congenital anomaly?

d) The weight of the baby?

e) P(e) for unstable lie.


1) Find the causes of hydrocephalus. TORCHES? Bleeding? Edward syndrome?

2) Observation of fetal condition through serial ultrasound. Check for any abnormality like spina bifida (associated with hydrocephalus)

3) 30 minutes CTG monitoring for fetal condition.

4) FBC and GSH for the mother

5) Blood sugar profile, Hba1c level of the mother.

6) Check for any complication of diabetes mellitus.



1) Pre term delivery is unlikely in this case; therefore corticosteroid injection is not needed.

2) Admit the patient at obstetric wards to observe the blood sugar level. Starts with diabetic diet. If fails, starts insulin.

3) Inform the pediatrician and neonatal neurosurgeon regarding delivery of baby and next intervention. (most likely caesarian section at 38-39w to prevent head entrapment)

4) Counseling to the patient regarding the baby condition. Congenital abnormality in DM is low. On next pregnancy should take folic acid to reduce risk of hydrocephalus.


1) Prep for C-sec

Post natal

1) Check CBS of the baby and mother

2) Admit baby to the NICU for further management.

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