RAJKUMARI AMRIT KAUR, COLLEGE OF NURSING, LAJPAT NAGAR, DELHI

CARE PLAN
ON

GESTATIONAL DIABETES
MELLITUS

SUBMITTED TO: SUBMITTED BY:

Dr. (Mrs.) MOLLY BABU SAVITA
HOD (OBS $ GYNE) Msc NURSING

IDENTIFICATION DATA
Name: -SHABANA

Age & Sex: - 24yrs/female

Ward & unit: - wd-4/unit-5

Bed no.: - 14

Reg. No. : - 15695

Mother’s Occupation: - housewife

Husband’s occupation: - works in a factory

Education: - 10th pass

Address: -H no.-331, Gyan Mandir Road Near Madina Masjid Badarpur, New Delhi

Date of Admission: -5 Feb. 2017

Income: - Rs. 8000-10000 per month

Gravid: -G₂P₁L₁

Diagnosis: - G₂P₁L₁ with 36+4 weeks with GDM with single high BP reading

High risk Score: -2

High risk Factors: - GDM (2)

SUBJECTIVE DATA

1. ADMISSION HISTORY: Patient having pain complaints since night then she went to badarpur PHC, they
checked B.P which comes out 160/96 mm hg from there they sent mother to safdarjung hospital. She
had her GCT reports with 199mg/dl done on 25/1/2017
She also have complaints of mild breathing discomfort.

2. PERSONAL HISTORY: She is married for 2yrs . They live in a rented house paying Rs. 1500 for rent, living
in a single room having kitchen in same room.
She is a non-vegetarian and has a normal bowel pattern. No habit of tobacco chewing or smoking. She
has normal sleep pattern of 5-6 hrs a day.

3. MEDICAL HISTORY: Patient have No history of T.B, HTN. No history of any skin infection.

4. SURGICAL HISTORY: No history of any surgical illness or any surgery.

5. FAMILY HISTORY: Shabana and her husband lives in a nuclear family in Delhi. They have one daughter
of 3yrs of age. Her husband is the only earning member. Rest of the family members live in village.
Shabana’s mother had DM and HTN. Rest of the family members have no history of T.B., DM, HTN and
epilepsy.
6. MENSTRUAL HISTORY: She attained her menarche at the age of 13 years. She had regular cycle of 28-
30 days and has a regular blood flow for 4-5 days, associated with mild dysmenorrheal. No history of
oligomenorrhea, menorrhagia, etc.
L.M.P.-22/06/2016
E.D.D.-29/3/2017

7. OBSTETRICAL HISTORY: She is G₂P₁L₁. She have one girl child before 3yrs. Previous delivery was in the
hospital only with no complications. Child was active and healthy.

8. HISTORY OF PRESENT PREGNANCY: 1st TTIMESTER- During her first trimester, she had mild nausea and
vomiting in morning that got relieved on its own. She was given 1 st dose of T.T after one month
received the second dose of T.T.
2nd TRIMESTER- Her ultrasound was done on 19/11/2016. Findings were SLIUF of 19+4 weeks,
placenta was found anteriorly low lying . She was advised to take maximum rest at that time.
3rd TRIMESTER- She also had an ultrasound on 29/01/2017. Findings were SLIUF of 28+3 weeks and
placenta lower end was found well above the internal os. EFW= 1.26gm. her GTT was done on
6/02/2017 and results was 219 mg/dl. 4Hourly monitoring of blood glucose was advised.

9. CHIEF COMPLAINTS OF PRESENT PREGNANCY – Mild pain in abdomen, frequent urination, fatigue,
cough and dry mouth, dry itchy skin.
OBJECTIVE DATA: Patient is looking anxious. She is having frequent urination.Urine output was 2700ml/
hr Her RBS reading were recorded as:
date BBF ABF BL AL BD AD
6/02/2017 75 88 84 113 110 132
7/02/2017 87 106 72 172 92 86
8/02/2017 73 83 76 158 99 112

PROGRESS NOTES AND MANAGEMENT AS PER CASE SHEET

DATE POG PULSE B.P. FHS P/A LPV BPV HEART/LU ADVICE
NGS
6/02/2 36+3 88/MIN 140/80 146/ Distend nil nil NAD To lie in left
017 WKS MMHG MIN ed, lateral
uterus position
relaxed,
cephalic
present
ation
7/02/ 36+4 80/min 130/80 132/ Distend nil nil NAD To split the
2017 wks mmHg min ed, lunch in two
uterus parts
relaxed,
cephalic
present
ation,
FHS
regular
8/02/ 35+5 92/min 130/80 142/ Distend nil nil NAD To monitor
2017 wks mmHg min ed, daily fetal
uterus count &
relaxed, report if she
 cephalic feels no
present movement
ation,
FHS
regular

TREATMENT GIVEN:

o Diabetic diet
o T. amoxyclav 625 mg TDS
o Syp. Grillinctus 2 Tsf TDS
o Steam inhalation TDS
o Tab. FS/OC/BC

PHYSICAL EXAMINATION
General Appearance :Normal built, General condition is fair, hydration is adequate, looks tired,

Conscious and oriented.

Head : hair is black in colour, no dandruff/ pediculosis is seen, scalp is seen

Eyes : Conjuctiva-no pallor, sclera - no yellowish discolouration

Pupils- reacting to the light, no evidence of eye infection

Nose : No septal deviation/ infection/ no blockage in nose

Ear : deafness, no infection/wax, no otitis media

Mouth : Gums- no bleeding, Toungue- dry, No evidence of glossitis/caries/ stomatitis/

tonsilitis

Neck : No evidence of thyroid sweeling and lymph node enlargement

Breast : Soft, secreting colostrums seconsary areola visible, nipples are normal, no

Evidence of short/long/inverted nipples.

Chest : Heart sound S1 & S2 is heard, lung sounds are normal and no evidence of

Wheezing or crackles.

Liver and spleen : No evidence of hepatospleenomegaly.

Upper extremitries : normal movement of abduction, adduction and rotation

Abdomen : INSPECTION: Linea nigra and striae visible in lower abdomen, abdominal girth – 40 cm ,
PALPATION: Fundal height – 36cm, height of uterus – 34 weeks, uterus is relaxed, active
fetal movements present, fetal parts felt, Auscultation: 146/min

GI system : normal intake of diet, bowel movements are normal, sometimes constipated
Bleeding per Vagina : Nil

Urine output : frequent urination , slightly increased, no burning micturation

Lower extremities : mild edema present, no varicose veins seen

INVESTIGATIONS
DATE INVESTIGATIONS REORT NORMAL VALUE
6/02/2017 -GCT 199Mg/dl Less than 140mg/dl
-TSH 3.o5 0.3-3µg/l
-HIV Non-reactive Non-reactive
-HbsAg Reactive Non-reactive
-VDRL Non-reactive Non-reactive
7/02/2017 -Hb 11.3gm/dl 12-14gm/dl
-TLC 14000/mm³ 5000-10000/mm³
-PLT 198000 lakh 1.5-3.5 lakh
-S. bil 0.41mg/dl 0.1-1mg/dl
-RBS 114mg/dl 80-120mg/dl
-KFT
 Blood Urea 12.6mg/dl 10-40mg/dl
 Serum Creatinine 0.8mg/dl 0.6-1.2mg/dl
 Uric Acid 4.0mg/dl 3.5-5.5mg/dl
Anti-HbsAg Negative Negative
Urine Routine normal normal
8/02/2017 -Sputum culture Negative Negative
-fundus NAD Normal
-HbA1c 7.2 <7
-Glucose tolerance test
FASTING 138mg/dl 105mg/dl
1 HOUR 222mg/dl 190mg/dl
2 HOUR 186mg/dl 165mg/dl
9/02/2017 -Hb 11.8gm/dl 12-14gm/dl
-TLC 12000/mm³ 5000-10000/mm³
-PLT 190000lakh 1.5-3.5 lakh
-S. bil 0.21mg/dl 0.1-1mg/dl
-FBS 78mg/dl 70-110mg/dl
-T. protein 7g/dl 6-8g/dl
-albumin 4g/dl 3.5-5g/dl
-KFT
 Blood Urea 14.8mg/dl 10-40mg/dl
 Serum Creatinine 1.1mg/dl 0.6-1.2mg/dl
 Uric Acid 3.2mg/dl 3.5-5.5mg/dl

On 6/02/2017, ultrasound was done, reports showed SLIUF in cephalic presentation, cardiac activity present,
placenta-fundo anterior , extending to rt lateral, Liquor-adequate, FL- 33wks 4 day.
ABOUT THE DIAGNOSIS
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without
previously diagnosed diabetes exhibit high blood glucose (blood sugar) levels during pregnancy (especially
during their third trimester). Gestational diabetes is caused when insulin receptors do not function properly. This
is likely due to pregnancy-related factors such as the presence of human placental lactogen that interferes with
susceptible insulin receptors. This in turn causes inappropriately elevated blood sugar levels.

Gestational diabetes generally has few symptoms and it is most commonly diagnosed by screening during
pregnancy. Diagnostic tests detect inappropriately high levels of glucose in blood samples. As with diabetes
mellitus in pregnancy in general, babies born to mothers with untreated gestational diabetes are typically at
increased risk of problems such as being large for gestational age (which may lead to delivery complications),
low blood sugar, and jaundice. If untreated, it can also cause seizures or stillbirth. Gestational diabetes is a
treatable condition and women who have adequate control of glucose levels can effectively decrease these risks.
The food plan is often the first recommended target for strategic management of GDM.

Women with unmanaged gestational diabetes are at increased risk of developing type 2 diabetes mellitus (or,
very rarely, latent autoimmune diabetes or Type 1) after pregnancy, as well as having a higher incidence of pre -
eclampsia and Caesarean section; their offspring are prone to developing childhood obesity, with type 2 diabetes
later in life. Most women are able to manage their blood glucose levels with a modified diet and the introduction
of moderate exercise, but some require antidiabetic drugs, including insulin.

INCIDENCE: Gestational diabetes affects 3-10% of pregnancies, depending on the population studied.GDM
rates are increasing and currently affect between 7% and 18% of pregnancies in the U.S. Increases in GDM rates
may result in a greater overall population with obesity and type 2 diabetes . GDM rates vary considerably by
race & ethnicity

Gestational diabetes mellitus (GDM) screening methods

1. All pregnant women are screened for GDM.

2. For the following pregnant women with a high risk of developing GDM, it is recommended that GDM
screening be omitted and diagnostic testing (75 g OGTT) carried out from the first.
3. Screening is carried out using the following two-step method.
 In the first trimester, a casual blood glucose test is carried out. Individual medical institutions may set
 their own cut-off values.
 A 50 g glucose challenge test (GCT) is carried out in the second trimester (weeks 24–28); the cut-off
 value is 140 mg/dl.
This test should be administered to pregnant women who tested negatively on the first-trimester
casual blood glucose test, or who tested positively on the first-trimester casual blood glucose test but
were diagnosed as non-GDM on 75 g OGTT.

PATHOPHYSIOLOGY: The precise mechanisms underlying gestational diabetes remain unknown. The
hallmark of GDM is increased insulin resistance. Pregnancy hormones and other factors are thought to interfere
with the action of insulin as it binds to the insulin receptor. The interference probably occurs at the level of the
cell signaling pathway behind the insulin receptor. Since insulin promotes the entry of glucose into most cells,
insulin resistance prevents glucose from entering the cells properly. As a result, glucose remains in the
bloodstream, where glucose levels rise. More insulin is needed to overcome this resistance; about 1.5-2.5 times
more insulin is produced than in a normal pregnancy.

Insulin resistance is a normal phenomenon emerging in the second trimester of pregnancy, which in cases of
GDM progresses thereafter to levels seen in a non-pregnant person with type 2 diabetes. It is thought to secure
glucose supply to the growing fetus. Women with GDM have an insulin resistance that they cannot compensate
for with increased production in the β-cells of the pancreas. Placental hormones, and to a lesser extent increased
fat deposits during pregnancy, seem to mediate insulin resistance during pregnancy. Cortisol and progesterone
are the main culprits, but human placental lactogen, prolactin and estradiol contribute, too. Multivariate stepwise
regression analysis reveals that, in combination with other placental hormones, leptin, tumor necrosis factor
alpha, and resistin are involved in the decrease in insulin resistance occurring during pregnancy, with tumor
necrosis factor alpha named as the strongest independent predictor of insulin sensitivity in pregnancy. An inverse
correlation with the changes in insulin sensitivity from the time before conception through late gestation
accounts for about half of the variance in the decrease in insulin sensitivity during gestation: in other words, low
levels or alteration of TNF alpha factors corresponds with a greater chance of, or predisposition to, insulin
resistance or sensitivity.

ETIOLOGY

IN BOOK IN PATIENT
 Positive family history (parents or siblings) Mother had diabetes
 Previous birth of an overweight baby of 4kg or more
 Previous stillbirth with pancreatic islet hyperplasia
 Presence of polyhydramnios or recurrent vaginal
candidiasis in present pregnancy
 Age over 30 years
 Obesity
 Ethnic group(east asian, pacific island ancestry)

SYMPTOMS
IN BOOK IN PATIENT
 Blurred vision  Vision is normal
 Fatigue  Patient looks tired
 Increased thirst  Patient is having dry mouth and
 Frequent infections, including those of the bladder, increased thirst
vagina, and skin  Not present
 Increased urination  Having frequent urination
 Dry skin  Patient is having dry skin
 Nausea and vomiting  Nausea and vomiting present in first
 Weight loss despite increased appetite trimester
 Increased appetite present

DIAGNOSTIC FINDINGS
IN BOOK IN PATIENT
Symptoms of ppolyuria, polydipsia, polyphagia Present in patient

GLUCOSE CHALLENGE TEST >140mg/dl GCT done -219mg/dl

GLUCOSE TOLETANCE TEST Fasting-138mg/dl, 1hr- 222mg/dl, 2 hr – 186mg/dl

HbA1c ->7 7.2

COMPLICATIONS
MATERNAL
During pregnancy
 Abortion: recurrent spontaneous abortion may be associated with uunconttrolled diabetes
 Pretem labour: may be due to infection or polyhydroamnios
 Infection- UTI and vulvo vaginitis
 Polyhydramnios (25% - 50%): it is a common association. Large baby, large placenta, fetal
hyperglycemia leading to polyuria, increased glucose concentration of liquor irritating the amniotic
epithelium or increased osmolarities are some of the probabilities.
 Increased iincidence of pre-eclampsia (25%)
 Maternal distress: may be due to combined effect of oversized fetus and polyhydroamnios
 Diabetic retinopathy
 Diabetic nephropathy
 Ketoacidosis

During labour
 Prolonged labour: due to big baby
 Shoulder dystocia: due to disproportionate growth with increased shoulder/heart ratio
 Perineal injuries Post partum haemorrhage
 Operative interference

During puerperium
 Puerperal sepsis
 Lactation failure

FETAL
 Fetal macrosomia
 Congenital malformation

MANAGEMENT
IN BOOK
 Dietary management
 Regular blood sugar charting
 Exercise
 Human insulin to be started if plasma
glucose level exceeds 90mg/dl and post
prandial glucose more than 200mg/dl
 Usg to be done for fetal well being and to
assess fetal size
 HbA1c, glycoalbumin, blood
biochemistry, peripheral
 blood in general: measured once per
month.
 Urine ketone bodies, protein,
qualitative measurementof urinary
glucose: twice per week
 Non-stress Test (NST) to be done weekly
afert 30 weeks
IN PATIENT
 On diabetic diet, diet chart given restricting
diet to 2000kcal
 4 hrly blood sugar charting is done
 Patient is advised to walk daily
 Patient is getting 2 units Regular insulin bbf,
before lunch and before dinner
 Usg was done, liquor was adequate and EFW
was normal
 HbA1c doen – 7.2
 Urine ketones are negative
 Nst done –non reactive
 NURSING MANAGEMENT

Nursing Diagnosis

Actual Nursing Diagnosis (Mother)

 Pain related to distention of abdomen
 Imbalance nutrition: less than the body requirement related to inability to utilize nutrients (imbalance
b/w intake utilization of glucose
 Activity intolerance related to increased energy demands and diseased condition
 Mild pain related to over distention of uterus
 Ineffective breathing pattern related to upper respiratory infection
 Imbalanced Imbalance nutrition: less than the body requirement related to inability to utilize
nutrients (imbalance b/w intake & utilization of glucose)
 Impaired skin integrity related to (polyuria) diseased condition
 Anxiety related to lack of knowledge about the condition and fetal outcome

Additional Nursing Diagnosis(Mother)

1. Risk for fluid volume deficit related to loss of fluids from the body due to polyuria
2. Risk for constipation related to immobility as evidenced by clients verbalizes of the physical discomfort.

NURSING PROCESS FOR MOTHER:

(1) Nursing diagnosis : Pain related to distention of abdomen

SUBJECTIVE DATA OBJECTIVE DATA
Patient complains of pain in abdomen Facial expression shows grimace, anxiety

DESIRED GOAL/ OUTCOME

patient will be relieved of pain to some extent.

PLANNING IMPLEMENTATION RATIONALE

 . Assess the intensity of -Pain was assessed. Dull in nature. To assess the intensity of pain.
pain. -comfortable left lateral position was -it helps to prevent supine
 -to give comfortable given hypotension due to vena cava
position compression
 -deep breathing to be -mind was diverted by asking questions -divert the mind from pain
taught -deep breathing exercises were taught Helps in relaxation of muscles
 EVALUATION OF GOAL
patient will be relieved of pain to some extent.

Nursing diagnosis : Imbalance nutrition: less than the body requirement related to inability to utilize
nutrients (imbalance b/w intake utilization of glucose)

SUBJECTIVE DATA OBJECTIVE DATA

The patient says her appetite has increased Patient’s blood glucose level are stable
PPBS= 178 mg/dl, HbA1c=7.2

DESIRED GOAL/ OUTCOME

patient will have normal pattern of eating

PLANNING IMPLEMENTATION RATIONALE

Assessment of assessed the nutrition status of the --for baseline data
nutritional status. patient. For maintaining a balanced diet
-Advice regarding diet -Advised The patient to eat highly
nutritious, light and easily digestible -To prevent further hyperglycemia
food.
-advised to avoid food high in calorie
content such as sugar, sweets, cakes, -For maintaining balance utilization of
fried food, potato etc. intake food
-advised for brisk walking and aerobic -to prevent hypoglycemia
exercise
-advised to eat food after 15 miin after
insulin administration

EVALUATION OF GOAL
Patient is maintaining a balanced diet by following the diabetic diet.
Patient is doing walk after meals

Nursing diagnosis Risk for fluid volume deficit related to loss of fluids from the body due to polyuria

SUBJECTIVE DATA OBJECTIVE DATA

Patient is complaining of frequent and excessive Patient looks lethargic and dehydrated. Total urine
urination output=2700ml/day

DESIRED GOAL/ OUTCOME

To reduce anxiety

PLANNING IMPLEMENTATION RATIONALE

-Assessment of hydration Examined the skin turgor and mucus
status. membrane
-assessment of intake and
output -monitor and measured intake &
output.
-monitored the vital signs.
-advised patient to have adequate fluid
consumption.
Helps in planning for further care of
patient.
-to determine hydration status.
-to prevent any complication.
To prevent further dehydration

EVALUATION OF GOAL
Patient is maintaining the hydration status.
-vitals are stable.

Nursing diagnosis Activity intolerance related to increased energy demands and diseased condition

SUBJECTIVE DATA OBJECTIVE DATA

Patient is complaining of weakness and fatigue and Patient looks dull and activity is restricted
reduced self activity

DESIRED GOAL/ OUTCOME

patient will be able to do self activity.

PLANNING IMPLEMENTATION RATIONALE

assessment of activity -Assessed the patient’s level of tolerance of -provides the baseline data.
tolerance level. activity. -to remove letharginess
-to reduce fatigue -advised and encouraged to do self activity To conserve energy.
like combing etc.
-Advised to tae rest between activities and To conserve energy
to take short nap at afternoon for 2-3hours. Provides energies and removes
-Advised to take night sleep for 6-8hours letharginess
Advised to take healthy diet rich in proteins, To remove dullness
vitamins and avoid fat.
-Advised to take brisk walking and exercises For providing baseline data.
-Assessed the patient’s skin for any .
breakdown.
-Advised to drink fluids.

EVALUATION OF GOAL
Patient is able to do do self activity, not so dependent.
-takes brisk walk and takes adequate rest.
.
DRUG STUDY

DRUG THERAPEUTIC ACTION DOSE NURSING

Ferrous sulfate replaces the iron
TAB stores found inn haemoglobin in
Ferrous sulfate red blood cells , myoglobin , and
other haeme enzymes . it allows
tranportaion of oxygen via
haemoglobin.
RESPONSIBILITY
Tablet /gems of ferrous Advised to take with lemon water ,
sulfate 200 mg O.D /B.D
with a glass of l Avoid intake of milk within 30 min
emon water for 100 days before and after taking iron
atleast
It will lead to black color of stool its
normal .

If used in syrup form causes

discoloration of teeth.

Must be continued till 100 days .

Never take iron with milk or milk

products.

Tab osteocalcium Calcium supplement Tablet osteocalcium 500 Assess patients serum calcium level ,
mg p.o o.d for 6 weeks so as to get the baseline data .

Educate to take calcium with milk .

Avoid taking iron and calcium

together .

Complete the coursideration as

advised .

SUMMARY OF PROGRESS OF MOTHER

My patient, Shabana, 24 years old female was admitted to ward-4 on 6/02/2017 with complaints of cough, mild
abdominal pain and one single reading high blood pressure. She also had her GCT raised -219mg/dl. She was started with
diabetic diet and 4 hourly sugar monitoring.

HEALTH EDUCATION
1. NUTRITION
 Advised the patient to eat well bal anced diet.
 It should be highly nutritious and easily digestible.
 Diet with 2000-2500Kcal/day for normal weight woman and restriction to 1200 -1800kcal/day for
overweight woman is recommended.
 Advised for high protein diet.
 Advised the diabetic mother to avoid foods like sweets, honey, sugar, cakes, fried foods, potatoes,
cold drinks etc.
 Advised to avoid food rich in fat and calories.
  Advised to take plenty of fluids (sugar free).
 Also advised to take meals after 15 min of insulin administration

DIABETIC CHART. (2000KCAL/DAY)

MORNING: Soup
BREAKFAST: tea-1cup(sugar free)
Brown bread/roti (2)/ dalia+ paneer
10-11am: fruit (1) + Miilk - ! glass (sugar free)
LUNCH: Roti (2) (wheat) – 50 gm
Green Vegetables – 150

Curd 150

Salad - 100 gm
3 pm: Fruit -100gm
EVENING time(5pm): soup /tea (sugar free)
DINNER: Roti(wheat) – 2 piece
Green vegetable – 200 gm
Salad - 150gm
Curd/paneeer – 100gm
Dal – 50gm

WHAT TO EAT
- Loki, lady’s finger, Tinda, Bitter gourd, raddish, kheera, onion
- Apple, guava, papaya
- Brinjal, cauliflower, bitter gourd-soup
- Milk (double toned) – 500m (milk/curd/tea)
- Paneer – 60gm/ egg (only white)
- Cereals + pulses – 150gm
- Vegetables, fruits – 100-200gm
- Oil – 6 small tsp
- Salt – half tsp; water

WHAT NOT TO EAT?

- Sugar, gem, honey, sweets, cake, pastry
- Dals like rajma, lobhia
- Coconut, cashewnut, pista
- Vegetables - Arbi, raw pea, tomato
- Fruits – Mango, banana, grapes, chickoo, watermelon
- Also chilli, coloured foods, tinned foods, pickels, pappad, fried iitems
- Avoid alcohol, tobacco, drugs etc

2. PERSONAL HYGIENE
- Maintain personal hygiene byy daily bath, combing, dress change
- Avoid exposure to infection, avoid crowds.
 3. REST
-TAKE REST : Sleep for 2-3 hrs in afternoon and 8-10 hrs at night
-Avoid remaining in one position
- Avoid strenuous work

4. ACTIVITY & EXERCISE

- Exercise and activities should be done according to the tolerance level.
- Brisk walking should be taken
- Self- care activities should be done (bathing, combing)

5. COMFORT MEASURES
- Wear comfortable clothes, wear loose clothes and avoid tight clothings.
- Avoid travelling in 1 st and 3 rd trimester
- Avoid long hours of standing or sitting in one position.
- Avoid coitus during 1 st and 3 rd trimester.

6. MEDICATION
- Taught methods about the method and techniques of injecting iinsulin; the dose, route and side effects.
- Advised to do self glucose monitoring before insulin administration.
- Advised to have meals atleast after 15 min of insulin administration.
- Advised patient to report any side-effects.

PROBLEM FACED BY PATIENT & STUDENT

The patient was worried about her condition and anxious especially about the well being of her child. She was
asking questions about the well being of her child.
Patient was very cooperative and followed all the advices given by me. No complaints from her side came.

CONCLUSION
Gestational diabetes mellitus is one of the leading cause of perinatal mortality. Early pre -conception
councelling and good antenatal care can prevent the complications and death of mother and fetus.

BIBLIOGRAPHY
 D.C. DUTTA, TEXTBOOK OOF OBSTETRICS, HHIRALAL KONAR, 7TH EDITION, PG NO,- 281-291
 AMY. M. KARCH, NURSING DRUG GUIDE, LIPPINCOTT (LWW) 2011, PG NO: 641, 703,