1/28. pregnancy outcome in aboriginal women with NIDDM in the Sioux Lookout Zone.PURPOSE: To review the pregnancy outcomes of Aboriginal women with non-insulin-dependent diabetes mellitus (NIDDM) in the Sioux Lookout Zone of Northwestern ontario, canada. METHOD: Retrospective chart review of deliveries of all women with a confirmed diagnosis of NIDDM was carried out between 1989 and 1992. RESULTS: During this period, 26 infants were born to 19 women with the diagnosis of NIDDM. Mean birth weight was 4,075 grams, with an average gestational age at delivery of 38 weeks. Three newborns required cesarean delivery, one required forceps, and one a vacuum extraction. There were four cases of shoulder dystocia. There were one stillbirth, one maternal death, and two cases of congenital heart disease. Ten newborns had neonatal jaundice and only two had neonatal hypoglycemia. These results suggest there is significant risk associated with NIDDM in pregnancy.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/28. Episodic hyperglycaemia in pregnant women with well-controlled Type 1 diabetes mellitus: a major potential factor underlying macrosomia.AIMS: To test the common assumption that pregnant women who are sufficiently motivated to achieve very good HbA1c levels will record home blood glucose data accurately. methods: A new device was used to download information from electronic blood glucose meters to assess the extent of selectivity in patient glucose diary-keeping. RESULTS: In an index case, a woman with excellent ambient HbA1c (5.9%; upper limit of normal 6.1%) was observed to have 68% of preprandial blood glucose readings above the target range of 3.5-6.5 mmol/l and a mean ( /- SD) level of 8.9 /-3.9 mmol/l in the corresponding period. No such impression was conveyed by the home monitoring diary. Six pregnant women with well controlled Type 1 diabetes (mean HbA1c 6.6 /-0.2%) exhibited between 42 and 68% of preprandial readings above the target range. CONCLUSIONS: The frequency of hyperglycaemia has hitherto been underestimated in well controlled pregnant women whose near-perfect home monitoring record is apparently corroborated by near-normal HbA1c levels. These observations provide a hypothesis for understanding of the disappointing continuance of macrosomia despite excellent HbA1c levels throughout pregnancy.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
3/28. Intra amniotic candidiasis. Case report and meta-analysis of 54 cases.We present a case of mid pregnancy loss with retained intrauterine contraceptive device associated with fetal candida infection. review of English literature identified 53 additional cases of fetal candidal infection, with 17 associated with an IUCD in situ. The presence of an IUCD was associated with delivery at a statistically significant earlier gestational age when compared to cases not associated with an IUCD (23.3 /- 4.9 vs 31.6 /- 7.0, p < 0.001). Seventy-seven percent of fetal candidal infections associated with an IUCD were systemic (heart, brain, liver, gastrointestinal, lung) compared to 33% of cases not associated with an IUCD. In contrast to bacterial intraamniotic infections there was a low incidence of maternal febrile morbidity. An hypothesis as to the pathogenesis of Candidal infections in the presence and absence of an IUCD is offered as well as a paradigm for the management of the gravid patient with an IUCD in situ.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
4/28. Obstetric emergencies precipitated by malignant brain tumors.OBJECTIVE: Our goal was to present a case series of pregnancy-associated malignant brain tumors. STUDY DESIGN: A review was conducted from 1978-1998 at 5 hospitals. RESULTS: Ten women were diagnosed with a malignant brain tumor during pregnancy (n = 8) or post partum (n = 2). patients diagnosed antenatally exhibited severe symptoms, manifest between 27 and 32 weeks' gestation. Six were emergently delivered of their infants because of maternal deterioration, and 2 were delivered electively in the early third trimester after documentation of fetal pulmonary maturity. There were 4 maternal deaths and 1 neonatal death; all of the other infants maintained viability. CONCLUSIONS: Malignant brain tumors rarely occur in pregnancy. In contrast to reports that describe an indolent course, each of the 8 antenatal patients experienced a neurologic crisis. If symptoms are amenable to pharmacologic control, we advocate delivery in the early third trimester after documentation of fetal pulmonary maturity. To minimize temporal lobe or cerebellar herniation in neurologically unstable patients, a consideration should be made for cesarean delivery with the patient under general anesthesia, followed by immediate neurosurgical decompression.- - - - - - - - - - ranking = 1.5keywords = pregnancy (Clic here for more details about this article) |
5/28. bulimia nervosa during pregnancy: a review.pregnant women with bulimia nervosa present interesting practice challenges for dietitians and healthcare professionals due to potential complications of bulimia nervosa for both mothers and fetuses. This review summarizes case study reports, case series reports, and retrospective studies of women with bulimia nervosa during pregnancy, and focuses on relationships among bulimic behaviors, pregnancy results, and birth outcomes. Pregnancy and birth outcomes of women with bulimia nervosa varied among individuals and studies. Material outcomes of concern included miscarriages, inappropriate weight gains (excessive or inadequate), complicated deliveries, and resumed and/or continued bulimic behaviors shortly after parturition. Fetal complications included low birth weights, prematurity, malformations, and low Apgar scores. Screening to detect bulimic behaviors is recommended, as is multidisciplinary treatment of pregnant women with bulimia nervosa to emphasize adequate dietary intakes, promote appropriate weight gains, and help achieve healthy infant outcomes in addition to long-term, healthy eating habits for these women. Future research regarding maternal and fetal outcomes of women with bulimia nervosa during pregnancy, conducted by registered dietitians, is needed to provide greater clarity and understanding of the impact of bulimic behaviors, dietary intakes, and nutritional status during pregnancy on maternal and fetal health.- - - - - - - - - - ranking = 4keywords = pregnancy (Clic here for more details about this article) |
6/28. Quadruplet pregnancy following a single course of clomiphene citrate. An expensive success.Prescribing clomiphene citrate for infertility patients has been taken very lightly. High order pregnancy can happen with this treatment. In addition to high perinatal mortality and morbidity of multiple pregnancy, the economic and social strains on the national health system and the family is great. The case presented showed that although the outcome of pregnancy was successful but the cost to the national health was tremendous. It is therefore recommended that measures should be taken to avoid high order births. Moreover, delaying the delivery, if possible, will be cost effective.- - - - - - - - - - ranking = 3.5keywords = pregnancy (Clic here for more details about this article) |
7/28. Sonographic prenatal diagnosis of marginal placental cord insertion: clinical importance.OBJECTIVE: To assess the impact of a sonographic diagnosis of marginal placental cord insertion on birth weight and duration of pregnancy. methods: A retrospective chart review was performed for 100 singleton pregnancies with prospectively identified marginal placental cord insertion. RESULTS: Birth weights below the 10th percentile occurred in 6.25% of pregnancies without preeclampsia. Spontaneous preterm delivery occurred in 7.3% of pregnancies without preeclampsia. Rates of birth weight below the 10th percentile and preterm delivery were not significantly different from those in the general population. Preeclampsia developed in 4 patients; all had elective preterm deliveries, and all gave birth to neonates with birth weights below the 10th percentile. CONCLUSIONS: A prenatal diagnosis of marginal placental cord insertion is not associated with increased risk of growth impairment or preterm delivery.- - - - - - - - - - ranking = 0.5keywords = pregnancy (Clic here for more details about this article) |
8/28. Placental growth hormone during pregnancy in a growth hormone deficient woman with type 1 diabetes compared to a matching diabetic control group.In pregnancy, pituitary growth hormone (GH) is gradually replaced by placental growth hormone (hPGH). GH deficient pregnant women may take advantage of GH substitution during pregnancy, but this issue still remains unresolved. Also, in pregnancy diabetes may cause macrosomia. The combination of GH deficiency, GH substitution therapy and type 1 diabetes mellitus may influence pregnancy in unforeseen ways. We present a case of pregnancy in a GH deficient woman with type 1 diabetes who continued on GH replacement until week 21. In gestational week 37 a thin and mildly small-for gestational-age (length 55 cm, 3 SD, 99th centile and weight 2445 g., -1.4 SD, 10th centile) but otherwise healthy boy was born. The patient had levels of serum hPGH at the lower end of the range of values found in a matching group of diabetic women. serum IGF-I levels were at the upper end of the range of values in the control group. A positive correlation between serum hPGH and IGF-I values was seen in the control group when using the area-under-the-curve (r=0.84; p<0.001). The patient's child had lower birth weight and ponderal index, but was otherwise healthy. serum IGF-I, but not hPGH, correlated to the absolute birth weight (r=0.63; p=0.015) and the birth weight z-score (r=0.55; p=0.039) in the control group. serum hPGH and IGF-I declined rapidly after delivery. In conclusion, hPGH correlated to IGF-I in type 1 diabetes mellitus (DM), and IGF-I values correlated to the birth weight. Both type 1 diabetes mellitus and GH deficiency (with GH substitution therapy) may influence fetal growth, and in combination, the net influence may be difficult to predict.- - - - - - - - - - ranking = 4.5keywords = pregnancy (Clic here for more details about this article) |
9/28. Excessive maternal weight and pregnancy outcome.OBJECTIVES: This study was undertaken to determine the influences of increased maternal prepregnancy weight and increased gestational weight gain on pregnancy outcome. STUDY DESIGN: This was a longitudinal retrospective study of 7407 term pregnancies delivered from 1987 through 1989. After excluding cases with multiple fetuses, stillbirths, fetal anomalies, no prenatal care, selected medical and surgical complications, and those with incomplete medical records, 3191 cases remained for analyses by determination of odds ratios for obstetric outcomes, by chi 2 tests for significant differences and by adjustment for risk factors with stepwise logistic regression. RESULTS: Both increased maternal prepregnancy weight (body mass index) and increased maternal gestational weight gain were associated with increased risks of fetal macrosomia (p less than 0.0001), labor abnormalities (p less than 0.0001), postdatism (p = 0.002), meconium staining (p less than 0.001), and unscheduled cesarean sections (p less than 0.0001). They were also associated with decreased frequencies of low birth weight (p less than 0.001). The magnitude of the last was less than that of the other outcomes. CONCLUSIONS: Increased maternal weight gain in pregnancy results in higher frequencies of fetal macrosomia, which in turn lead to increased rates of cesarean section and other major maternal and fetal complications. Because these costs of increased maternal weight gain appear to outweigh benefits, weight gain recommendations for pregnancy warrant careful review.- - - - - - - - - - ranking = 4.5keywords = pregnancy (Clic here for more details about this article) |
10/28. superfetation as a cause of growth discordance in a multiple pregnancy.A triplet pregnancy is described, in which the diagnosis of in utero growth restriction is questioned after postnatal suspicion of superfetation, by using neurosonography and ophthalmic examination to aid gestational age assessment.- - - - - - - - - - ranking = 2.5keywords = pregnancy (Clic here for more details about this article) |
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