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Management of a labour complicated by diabetes

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Delivery should be by the vaginal route unless there are obstetric contraindications.

If the labour is planned then breakfast and insulin should be omitted.

Management of blood glucose is by intravenous infusion:

  • 10% dextrose (1 litre/12 hours)
  • insulin by slow infusion (typically 0.5-2.0 u/hr)
  • the target range for glucose concentration is 4.0-5.8 mM

All other infusions should not contain dextrose.

Foetal distress is more common in diabetic labours. Continuous CTG monitoring is required; when there is concern, foetal scalp blood should be analysed for pH and gases.

Shoulder dystocia is rare with good diabetic control. Any suspicion of cephalopelvic disproportion is an indication for caesarian section.

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