The management of women with pre-existing diabetes is inherently complex due to the potential for significant adverse maternal and neonatal outcomes with enduring consequences.
The peri-partum phase is a high-risk period during pregnancy due to the number of factors that are difficult to control and due to the increased risk for developing poor outcomes. It is complicated by the variable demands of labour, the dynamic nature of presentations necessitating quick decision making, confounding factors which influence outcomes such as need for antenatal corticosteroid therapy and potential dietary restrictions especially in anticipation of an operative delivery, Increasing access to diabetes technology has complicated this further especially with complexity around responsibility of blood glucose monitoring and decision-making regarding insulin administration. While this is challenging, diabetes technology also provides an immense opportunity to optimise outcomes with its efficient and effective use.
The South Australian Perinatal Practice Guidelines (SAPPG), Australasian Diabetes in Pregnancy Society (ADIPS) guidelines and Diabetes Technology Standards developed by the National Association of Diabetes Centres (NADC ) provide a framework to assist with delivery of care in this setting. A continuous improvement project was conducted by the Diabetes in Pregnancy team at Flinders Medical Centre in April 2022 to evaluate existing processes and to optimise peri-partum care and consequently improve maternal and neonatal outcomes.
The patient journey was mapped, and the processes involved in peri-partum planning and management of women with pre-existing diabetes was examined for areas of variability. A root cause analysis was undertaken to identify causes of variability and the effects of these were delineated. The findings of this project illustrate the challenges and opportunities faced by clinical teams working at the patient’s bedside in translating research into practice and the resources that would be necessary to make this viable and sustainable.