Glucose and insulin in labour

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Glucose and insulin are given by intravenous infusion for all vaginal deliveries as follows:

Intravenous dextrose (10%): one litre every eight hours delivered at a steady rate.

Intravenous insulin: soluble insulin diluted in physiological saline (1 unit insulin/ml saline) and administered by infusion pump at about 1 unit/h (usual range 0-5-2 units/h). If very low infusion rates are used the insulin concentration can be halved.

Blood glucose concentrations should be maintained in the range 4-0-7-0 mmol/l. Insulin infusion is continued until the patient can restart her normal meals. The pre-pregnancy insulin dose is then restarted, otherwise severe hypoglycaemia will occur; if the patient was not previously on insulin, the insulin dose is halved.

Head circumference (mean ± 2SD)

Head circumference (mean ± 2SD)

Birth weight

.. Menstrual age 40 (weeks)

Abdominal circumference (mean ± 2SD)

30 40

Birth weight

.. Menstrual age 40 (weeks)

Abdominal circumference (mean ± 2SD)

30 40

Menstrual age (weeks)

Ultrasound measurement of fetal growth showing excessive increase of abdominal girth, indicating delivery of a large baby

Blood glucose regimen in

labour

Blood glucose

Infusion rate

<4-0 mmol/l*

G^5 U/h

4-0-7-0 mmol/l

1 U/h

>7-0 mmol/l

2 U/h

*If the blood glucose concentration decreases to <3-0mmol/1, insulin infusion can be stopped for up to 30 minutes.

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