A Peculiar Case of Fetal Distress Leading to the Diagnosis of Diabetic Ketoacidosis in Pregnancy
Bibliographic record
Abstract
Diabetes ketoacidosis (DKA) in pregnancy is associated with significant maternal and neonatal morbidity. It is rare for women without a prior history of diabetes mellitus (DM) to develop DKA. This case report describes an atypical presentation of DKA in a 38-year-old primigravida, with no history of DM, presenting with "unexplained" fetal distress. She presented at 25 weeks to our labor ward triage with an unrelated complaint of prolapsed piles. There were no complaints of reduced fetal movement, abdominal or contraction pains or per vaginal bleeding. Ultrasonography showed an appropriately grown fetus with normal liquor volume. Incidental fetal distress was picked up on a cardiotocography (CTG) which showed a fetal heart rate of 150 beats per minute with reduced variability and shallow decelerations. The unlikely diagnosis of DKA was suspected when a random capillary blood glucose (CBG) level returned as "HI". Investigations revealed the triad of elevated venous glucose, raised serum ketones and high anion gap metabolic acidosis (with a maternal pH of 7.14), consistent with the diagnosis of DKA. She was aggressively treated with intravenous insulin and hydration therapy. Fetal distress resolved with resolution of the DKA. She eventually delivered a healthy baby at 37-week gestation. This case raises awareness of a rare occurrence of DKA in late pregnancy as the first presentation of DM and highlights the importance of considering a hyperglycemic crisis as a potential cause of a suspicious CTG in an asymptomatic woman without any clear reason for fetal distress. Timely diagnosis and prompt treatment of the underlying condition is lifesaving, and avoids urgent delivery and risks associated with prematurity.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".