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Background <p>Diabetic ketoacidosis (DKA) during pregnancy is a rare but life-threatening complication associated with high fetal mortality. Prompt metabolic stabilization is essential, although emergency cesarean delivery may be required. Reports on anesthetic management are limited.</p> Case presentation <p>A 24-year-old primigravida with poorly controlled type 2 diabetes presented at 35&#xa0;weeks of gestation with nausea and non-reassuring fetal status (NRFS). DKA was confirmed using laboratory tests. Emergency cesarean delivery was performed for NRFS before complete stabilization. Metabolic management was conducted by endocrinologists and anesthesiologists. Combined spinal-epidural anesthesia (CSEA) was intraoperatively administered by anesthesiologists with real-time hemodynamic and metabolic management guided by arterial blood gas analysis using an arterial line while continuing insulin and glucose therapy. Postoperatively, metabolic derangements resolved, and the mother and neonate were discharged without complications.</p> Conclusions <p>This case demonstrates that emergency cesarean delivery for uncorrected DKA can be achieved using CSEA, timely hemodynamic support, and coordinated metabolic management.</p>

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Perioperative management of emergency cesarean delivery in a pregnant woman with uncorrected diabetic ketoacidosis: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Satoshi Naruse,
  • Takaki Kasai,
  • Momoka Kojima,
  • Hiroshi Ueda,
  • Chieko Akinaga,
  • Yoshiki Nakajima

摘要

Background

Diabetic ketoacidosis (DKA) during pregnancy is a rare but life-threatening complication associated with high fetal mortality. Prompt metabolic stabilization is essential, although emergency cesarean delivery may be required. Reports on anesthetic management are limited.

Case presentation

A 24-year-old primigravida with poorly controlled type 2 diabetes presented at 35 weeks of gestation with nausea and non-reassuring fetal status (NRFS). DKA was confirmed using laboratory tests. Emergency cesarean delivery was performed for NRFS before complete stabilization. Metabolic management was conducted by endocrinologists and anesthesiologists. Combined spinal-epidural anesthesia (CSEA) was intraoperatively administered by anesthesiologists with real-time hemodynamic and metabolic management guided by arterial blood gas analysis using an arterial line while continuing insulin and glucose therapy. Postoperatively, metabolic derangements resolved, and the mother and neonate were discharged without complications.

Conclusions

This case demonstrates that emergency cesarean delivery for uncorrected DKA can be achieved using CSEA, timely hemodynamic support, and coordinated metabolic management.