Maseko Ncamsile F, van Zyl Danie, Adam Sumaiya
Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Department of Internal Medicine, University of Pretoria Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.
Int J Gynaecol Obstet. 2022 Sep;158(3):557-563. doi: 10.1002/ijgo.14093. Epub 2022 Jan 31.
Diabetic ketoacidosis (DKA) during pregnancy is associated with increased rates of maternal and perinatal mortality and morbidity. DKA management guidelines are designed to ensure optimal management and minimize adverse outcomes.
To determine the level of adherence to DKA management guidelines at a tertiary center in Pretoria, South Africa and report on maternal and perinatal outcomes of the pregnancies complicated by DKA.
This was a retrospective clinical record audit using the Society for Endocrinology, Metabolism and Diabetes of South Africa guidelines against documented management. Adherence to three cornerstones of therapy was measured: intravenous fluids, insulin therapy, and management of electrolytes.
Fifty-six records of pregnancies that were complicated with DKA over a 10-year period were reviewed. Mean age was 29.6 years (range 20-43 years). Thirty-six (64.3%) women had type 1 diabetes mellitus. DKA was categorized into mild (n = 26, 46.4%), moderate (n = 22, 39.3%), and severe (n = 8, 14.3%). The study demonstrated lack of adherence to the three cornerstones of therapy. Of the 49 (85.7%) women with recorded perinatal outcomes, 30.6% had stillbirths. Severe maternal DKA (pH <7.0) demonstrated adverse perinatal outcomes (P = 0.005).
Despite the availability of guidelines, DKA is sub-optimally managed in pregnancy, which may contribute to adverse maternal and perinatal outcomes.
妊娠期间的糖尿病酮症酸中毒（DKA）与孕产妇及围产期死亡率和发病率的增加相关。DKA管理指南旨在确保最佳管理并将不良后果降至最低。
确定南非比勒陀利亚一家三级中心对DKA管理指南的遵守程度，并报告并发DKA的妊娠的孕产妇和围产期结局。
这是一项回顾性临床记录审核，使用南非内分泌、代谢和糖尿病学会的指南对照记录的管理情况。衡量对治疗三大基石的遵守情况：静脉输液、胰岛素治疗和电解质管理。
回顾了10年间56例并发DKA的妊娠记录。平均年龄为29.6岁（范围20 - 43岁）。36名（64.3%）女性患有1型糖尿病。DKA分为轻度（n = 26，46.4%）、中度（n = 22，39.3%）和重度（n = 8，14.3%）。该研究表明对治疗的三大基石缺乏遵守。在有围产期结局记录的49名（85.7%）女性中，30.6%发生死产。严重孕产妇DKA（pH <7.0）显示围产期结局不良（P = 0.005）。
尽管有指南，但妊娠期间DKA的管理未达到最佳状态，这可能导致不良的孕产妇和围产期结局。
