@inbook{d1643bcb469248b89654d5897b481306,
title = "Can structured education allow women to effectively self-manage csii during the intra-partum period",
abstract = "Continuous subcutaneous insulin infusion (CSII) is an effective method of maintaining blood glucose targets for selected women during pregnancy. However a lack of professional knowledge regarding CSII may be a barrier to its use, especially during the complex and dynamic intra-partum stage. To enhance the birthing experience a specialist multidisciplinary antenatal clinic service developed guidelines and a structured education programme empowering women to self-manage their diabetes during the intra-partum period. Pregnant women attending the service underwent regular review and education which included self-management in the intra-partum period and individualised CSII birth plans. To date sixty-seven pregnancies have booked into the service (36 primigravidas, 66 Type 1 diabetes) with 58 deliveries (initial HbA1c 53.8 ±11.9 (36-89) mmol/mol (mean,SD(range)), age 30.75 ±5.09 (19-41) years, diabetes duration 14.4 ±8.12 (0-32) years. Prior to CSII all experienced frequent hypoglycaemic events. Thirty-three women converted onto CSII during pregnancy (range 5-25 weeks gestation). Complications included 26 retinopathy, 10 hypertension, 2 nephropathy and 3 gastroparesis. From this group, 58 women have delivered and self-managed CSII in the intra-partum period (gestation 35.5 ± 2.92 (23-38.4) weeks, birth weight 3877 ± 5496 (1050-3965)g). All women maintained self-testing blood glucose values below 9mmol/l. Forty-one needed caesarean section under spinal anaesthetic and 34 received corticosteroids due to prematurity risk. Thirtyfour infants were admitted to special care (20 prematurity, 12 hypoglycaemic). Pre-delivery HbA1c was 49 ± 8.67 (33-78) mmol/mol with no major hypoglycaemic episodes. Training eliminates professional anxieties and inexpert attempts to discontinue CSII too early are otherwise pre-empted. With support and education, women can be empowered to self-manage CSII and maintain appropriate glycaemic targets during the intra-partum period.",
keywords = "*diabetes mellitus, *education, *female, *human, anesthetic agent, anxiety, birth weight, cesarean section, corticosteroid, glucose blood level, hemoglobin A1c, hospital, hypertension, infant, insulin dependent diabetes mellitus, insulin infusion, kidney disease, medical specialist, pregnancy, pregnant woman, prematurity, primigravida, professional knowledge, retinopathy, risk, self care, self evaluation, stomach paresis",
author = "Purewal T.S. and Morrison G. and Spelman S. and Morrison C. and Abayomi J. and Woods L. and Walkinshaw S.A.",
year = "2013",
language = "English",
isbn = "0012-1797",
series = "Diabetes",
publisher = "American Diabetes Association Inc.",
pages = "A684",
booktitle = "Diabetes",
address = "United States",
}
