A G2 P1+0+0 diabetic mother present at 32 weeks pregnancy, there is history of full term fetal demise in last pregnancy. Her vitals are stable, sugar is controlled and fetus is stable. Which among the following will be the most appropriate management?

Explanation

The most common time of IUD in a diabetic patient is last two weeks of pregnancy, since in this patient there is history of a full term demise as well, so logically speaking we should terminate her pregnancy at 38 weeks.This is what logic says, now let us see what references have to say- High risk gestational diabetes: History of stillbirth History of neonatal death History of fetal macrosomia Concomitant obesity and/or hypertension Development of oligohydramnios, polyhydramnios preeclampsia or fetal macrosomia Inadequate metabolic control with diet alone. “High risk gestational diabetic patients should have their labor induced when they reach 38 weeks with exception of those with a macrosomia fetus (Efw > 4000 g) who should be delivered by cesarean section because of the increased risk of shoulder dystocia”. Fernando Arias 3/e, p 449 Induction of labor: The indications are Diabetic women controlled on insulin (GDM or class B diabetes) are considered for induction of labor after 38 completed weeks Women with vascular complications (pre-eclampsia, IUGR) often require induction after 37 weeks.