Importance of cardiotocography and its interpretation in gestational diabetes"

Abstract

To present the clinical case of a 39-year-old pregnant woman, multigravida at 37.3 weeks according to second-trimester ultrasound, with no prior history of diabetes or family history of diabetes. However, her obstetric history included fetal death, spontaneous abortion, and hospitalization one month earlier for uncontrolled gestational diabetes. The patient presented to the emergency department of a healthcare institution on August 26, 2017, at 10:24 a.m. due to decreased fetal movements for two days. Two fetal well-being tests were performed: a non-stress test (NST) with a non-reassuring pattern and a biophysical profile (BPP) indicating 37 weeks of gestation with a score of 6/8, nuchal cord, and an estimated fetal weight of 3329 grams. Blood glucose was 63 mg/dL. An endocrinology consultation recommended continuous glucose monitoring, dietary adjustments, and insulin treatment. With these clinical findings, the patient was transferred to the delivery room, where a stress test (CST) yielded unsatisfactory results. At 10:44 p.m., due to the absence of an indication for delivery and a glucose level of 62 mg/dL, the on-duty physician recommended hospitalization. Fetal heart rates were monitored every three hours during the night and found to be normal. However, at 8:00 a.m., fetal heart sounds were absent, confirmed by ultrasound, leading to an abdominal delivery. Operative findings: fetal death, female fetus, APGAR 0/0, Capurro: 37 weeks, weight: 3280 grams, placenta: 500 grams with complete cotyledons, intact membranes, thick meconium-stained amniotic fluid in small quantities, and a slightly tightened single nuchal cord. Conclusion: Proper recording and interpretation of cardiotocographic parameters in electronic fetal monitoring in diabetic pregnant women are crucial to identifying fetal risks, ensuring timely management, and preventing maternal and perinatal complications.

El propósito de este trabajo es presentar el caso clínico de una gestante de 39años, multigesta de 37.3 semanas x ECO II Trimestre, sin antecedente previo de diabetes ni historia familiar de diabetes, pero con antecedentes obstétricos de óbito fetal, aborto espontáneo y haber estado hospitalizada hace un mes por diabetes gestacional no controlada. La paciente acude el 26 de agosto del 2017 a las 10:24 am al servicio de emergencia de una institución de salud por disminución de movimientos fetales hace 2 días; donde se le solicita dos pruebas de bienestar fetal: Un test no estresante con resultado patrón no tranquilizador y un perfil biofísico que concluyo con gestación de 37 semanas xBMF/PBF 6/8 /circular de cordón/ponderado fetal de 3329 gr. Glucosa de 63mg/dl. La interconsulta con endocrinología sugiere monitorización permanente de glicemias, dieta y tratamiento con insulina. Con estos datos clínicos la paciente pasa a sala de partos donde se le realiza un test estresante que concluye con CST insatisfactorio. A las 22:44 pm, al no haber indicación de término de gestación y con glicemia de 62mg/dl, el médico de turno indica pasar a hospitalización. Durante la noche se monitoriza los latidos cardiacos fetales cada 3hs. normales, sin embargo a las 8:00am ausentes, se confirma con la ecografía y culmina el embarazo en parto abdominal. Hallazgos operatorios: Óbito Fetal, sexo femenino, APGAR 0/0, Capurro: 37Sem, peso: 3280gr., placenta de 500gr con cotiledones completos, membranas completas, líquido meconial espeso en escasa cantidad, circular de cordón simple levemente ajustado. Conclusión: Es importante el correcto registro e interpretación de los parámetros cardiotocográficos del monitoreo electrónico fetal en gestantes con diabetes porque permite la identificación del riesgo fetal, un manejo oportuno y prevención de complicaciones materno perinatales.