POOR GLYCEMIC CONTROL DURING PREGNANCY LEADING TO INTRAUTERINE FETAL DEMISE IN A HIGH-RISK PREGNANCY: A CASE REPORT

Background: Intrauterine fetal demise (IUFD) remains an important contributor to perinatal morbidity and mortality. Maternal glucose dysregulation and inadequate glycemic control during pregnancy significantly increase the risk of adverse maternal and fetal outcomes. Early identification of high-risk pregnancies, strict glycemic monitoring, and timely obstetric intervention may reduce such complications. Case Presentation: A 38-year-old multigravida with history of recurrent pregnancy loss (three previous abortions) and Type 2 diabetes mellitus presented to the Prasuti Tantra and Stri Roga OPD on 06/05/2025 at 39 weeks of gestation with complaints of absent fetal movements for one day. The pregnancy was complicated by severe maternal hyperglycemia, irregular antenatal follow-up, advanced maternal age, and recurrent pregnancy losses. Preconception Ayurvedic fertility management included one cycle of Uttarbasti with Phalaghrita, following which conception occurred after two menstrual cycles. The patient had been receiving oral hypoglycemic medications prior to pregnancy and insulin therapy during pregnancy was initiated on physician advice and continued throughout antenatal care because of poor glycemic control. She had also been advised diabetic dietary modifications, regular monitoring, and supportive Ayurvedic management. Considering the high-risk nature of pregnancy, elective lower segment cesarean section (LSCS) at 37 weeks had been advised; however, the patient did not undergo the recommended intervention. Ultrasonography confirmed intrauterine fetal demise. Laboratory investigations revealed severe hyperglycemia with random blood sugar of 284 mg/dL and HbA1c of 15.0%. Conclusion: This case highlights the importance of strict glycemic control, regular antenatal surveillance, dietary regulation, patient counseling, and timely obstetric intervention in preventing adverse fetal outcomes in high-risk pregnancies.