Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 112

For those known to have diabetes, preconception care and counseling (PCC) aim to optimize the woman’s physical, social and emotional wellbeing preconceptually, to ensure healthy intra‐uterine environment for the developing fetus [10]. This has been shown to significantly reduce the risk of major and minor congenital anomalies in women with established diabetes mellitus [11], hence is the most important management step for a patient with diabetes planning to conceive through ART. There is great consistency in international guidelines on preconception care for the patients with diabetes especially on recommendations such as multidisciplinary approach involving social health professionals and counselors, optimal preconception HbA1c of between 6–7 %, medication review with respect to feto‐maternal safety profile, commencing high dose (5mg daily) folic acid, screening and management of diabetic complications and advising appropriate contraception until optimal metabolic control is achieved [12]. In Case History 1 with a high HbA1c of 12%, the woman requires referral to the multidisciplinary team for optimization of her glycemic control and preconception counseling as per international guideline recommendations in order to reduce the risk of adverse feto‐maternal outcomes.

Ovarian hyperstimulation syndrome (OHSS) should always be ruled out in any symptomatic woman who has undergone controlled ovarian stimulation. In Case History 1, on day 5 after oocyte retrieval, the woman’s symptoms could be related to infection and she will therefore require ruling out of pelvic infection (appropriate diagnostic work up in order to initiate targeted treatment). Uncontrolled diabetes and infection are a dangerous combination and can predispose to diabetic ketoacidosis. A high index of suspicion and early involvement of the specialized multidisciplinary team are therefore warranted.