This was May's unplanned 4th pregnancy. She had a history of preeclampsia and had been managing type 2 diabetes with insulin for 10 years, putting her at high risk for recurrent preeclampsia. Under the care of the Tam Anh General Clinic in District 7, she received preventative aspirin for preeclampsia and consultations with a cardiologist to manage her hypertension and dyslipidemia.

Doctor Long performs an ultrasound on a pregnant woman at Tam Anh General Clinic in District 7. Illustrative photo: Thanh Luan

According to Doctor Nguyen Hoang Long, Deputy Director of the Fetal Medicine Center at Tam Anh General Hospital in TP HCM, close monitoring of May's pregnancy was crucial for a safe delivery. Her diabetes carried the risk of developing ketoacidosis, a condition where the body, lacking sufficient insulin to process glucose, burns fat for energy instead. This process creates waste products called ketones, which accumulate in the blood, elevating uric acid levels. Pregnant women with diabetes also face the risk of hypoglycemia, while their babies are at risk of birth defects, fetal distress, slow growth, sudden fetal cardiac arrest, premature birth, hypoglycemia, and respiratory distress after birth.

Endocrinologists adjusted May's insulin dosage for her pregnancy and guided her in monitoring her blood sugar at home. She followed a diet low in sugar and carbohydrates, high in protein (meat, fish, eggs, milk), and rich in vegetables. She also ate smaller, more frequent meals, exercised regularly according to her physical condition, and ensured adequate sleep to manage her blood sugar levels.

May had monthly check-ups to monitor her health and the baby's development. At 20 weeks, a Doppler ultrasound revealed increased uterine artery resistance, potentially indicating vascular damage due to complications from diabetes and chronic hypertension. This could lead to placental dysfunction, restricting blood, oxygen, and nutrient supply, putting the fetus at risk of intrauterine growth restriction and stillbirth.

May also experienced low amniotic fluid. Doctor Long monitored her weekly, assessing her amniotic fluid index (AFI) and other indicators. At 36 weeks, the diagnosis was intrauterine growth restriction, abnormal umbilical artery Doppler, and severely low amniotic fluid at 2.5 cm with the largest pocket measuring about 1.5 cm. Fetal movement also decreased. An emergency C-section was performed, and a baby girl weighing 2.3 kg was delivered. Both mother and baby were stable.

Oligohydramnios, or low amniotic fluid, occurs when the amniotic fluid volume is below 5 cm, the maximum vertical pocket (MPV) is less than 2 cm, and the amniotic membrane is intact. It is most severe when the AFI is less than 2 cm. Occurring before 28 weeks, it can lead to miscarriage, stillbirth, premature birth, or birth defects. Treatment is tailored to the specific circumstances of the mother and fetus.

Doctor Long recommends that pregnant women with underlying conditions like hypertension, dyslipidemia, and diabetes receive regular check-ups at well-equipped, multi-specialty medical facilities. Postpartum, women should continue appropriate treatment for their underlying conditions to prevent cardiovascular disease, stroke, and kidney and urinary problems.

Ngoc Chau

* The patient's name has been changed.