1/20. 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 = 1keywords = macrosomia (Clic here for more details about this article) |
2/20. Perlman syndrome: four additional cases and review.Perlman syndrome was first described in 1973 and comprises nephromegaly with renal dysplasia and wilms tumor, macrosomia, cryptorchidism, and multiple facial anomalies. polyhydramnios and hypoglycaemia are often found. Twelve children have been described from six different families. Five came from one family whose Yemenite Jewish parents were second cousins. Autosomal recessive inheritance has been suggested. prognosis is severe with neonatal death in most children. We report on 4 new cases of Perlman syndrome from 3 families; all parents were non-consanguineous. Some of the observed manifestations have been described only once in this syndrome (cardiac defect, hepatic fibrosis with portoportal bridging, haemangioma) or never before (volvulus, intestinal atresia, and agenesis of the corpus callosum in 1 patient, a cleft palate in another). All children died within the first year. The 2 sibs were born prematurely with nephromegaly but without hamartomas or nephroblastomatosis. This is consistent with the hypothesis that dysplastic medullary parenchyma in preterm infants develops into nephroblastomatosis and hamartoma and eventually wilms tumor.- - - - - - - - - - ranking = 0.2keywords = macrosomia (Clic here for more details about this article) |
3/20. Are conventional targets for metabolic control sufficient to prevent fetal macrosomia during diabetic pregnancy?We report the case of a 26 year-old woman, with an uncomplicated type 1 IDDM of 17 yr duration followed for her first pregnancy. At conception, HbA1c (measured by HPLC) was 6.5% and fructosamine was 280 u.mol.l (normal range below 285). During the follow-up, 15-days-interval frutosamine never exceeded the normal range and HbA1c values were under 6.5% excepted in the third trimester (7.0 /- 0.8%) coinciding with a bad control of the 2 hours post-prandial blood glucose. A fetal macrosomy was discovered at 34 weeks of gestation and a heavy-for-date 4680 g baby was delivered by caesarean section at 38 weeks of gestation. Our case report outlines again the need to achieve the recommended target of metabolic control for the diabetic pregnant woman (blood preprandial glucose: 3.9-5.6 mM; post-prandial 2 h < 6.7 mM) specially during the third trimester of pregnancy. The use of computer databases might be helpful for precise monitoring during this narrow window period.- - - - - - - - - - ranking = 3.4565489145905keywords = fetal macrosomia, macrosomia (Clic here for more details about this article) |
4/20. Arrest of descent in second stage of labour secondary to macrosomia: a case report.BACKGROUND: fetal macrosomia, defined as birth weight greater than 4000 g, complicates 10% of pregnancies and is a well-documented cause of prolonged second stage of labour, as well as of arrest of descent of the fetal presenting part. CASE: A multigravida woman with gestational diabetes mellitus was admitted in labour at term, and progressed to full dilatation. The fetal vertex failed to descend beyond -3 station. An emergency Caesarean section was performed and a 6452 g male infant was delivered. CONCLUSION: physicians should be aware of the possibility of macrosomia as the cause of failure of descent in the second stage. A heightened state of suspicion should be maintained, particularly in a multigravida woman with a prior macrosomic baby and the presence of other predisposing factors such as gestational diabetes mellitus.- - - - - - - - - - ranking = 1.2keywords = macrosomia (Clic here for more details about this article) |
5/20. 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 = 1.7282744572952keywords = fetal macrosomia, macrosomia (Clic here for more details about this article) |
6/20. Pregnancy in a woman suffering from type 1 diabetes associated with Addison's disease and Hashimoto's thyroiditis (fully developed Autoimmune Polyglandular syndrome Type 2).In this article the pregnancy of a woman suffering from the complete triad typical of Autoimmune Polyglandular syndrome Type 2 (Addison's disease type 1 diabetes Hashimoto's thyroiditis) is reported. By using insulin pump therapy with insulin lispro, it was possible to balance diabetes control with changes of steroid replacement therapy. Pregnancy was uneventful until week 27, when signs of preeclampsia occurred. The boy was born without difficulty at gestational age 37 weeks by planned cesarean section but signs of diabetic fetopathy (macrosomia, hypoglycaemia and hypocalcaemia) were expressed. He required a short course of hydrocortisone therapy. He made a good and rapid recovery. The mother made a good post-operative recovery too, but 4 months after the delivery microalbuminuria as well as mild hyperuricemia are still present. Interdisciplinary approach and very careful observation of the mother as well as of the child enabled successful outcome of this highly risky pregnancy.- - - - - - - - - - ranking = 0.2keywords = macrosomia (Clic here for more details about this article) |
7/20. A provisionally unique syndrome of macrosomia, bone overgrowth, macrocephaly, and tall stature.We report a young man with intrauterine macrosomia, macrocephaly, and bony abnormalities. Excessive growth continued throughout infancy and childhood. Bone age was advanced. He developed contractures of the large joints and was confined to a wheelchair. Extensive laboratory studies, repeated on multiple occasions were all normal. Intellectually, he was normal. His near final height was 234 cm. The constellation of findings in this patient is at variance with previously described syndromes of tall stature. We postulate that excessive size and bone overgrowth in this young man is caused by a receptor/post-receptor abnormality involving a growth on/off mechanism at the cellular level.- - - - - - - - - - ranking = 1keywords = macrosomia (Clic here for more details about this article) |
8/20. Fetal hemangiopericytoma with an associated cerebral anomaly.We report the first case of infantile hemangiopericytoma explored prenatally by fetal ultrasonography and magnetic resonance imaging (MRI). It was associated with a developmental cerebral anomaly identified on MRI. The largest lesions of the multifocal hemangiopericytoma were located in the soft tissue adjacent to the left temporal bone, and smaller lesions were found in the lumbar area and in the retroperitoneum. MRI showed no connection between the tumor and the fetal brain but there was anomalous cerebral gyration in the region and the Sylvian fissure beneath the tumor was enlarged. The pregnancy was terminated because of the severe brain anomalies and postmortem examination confirmed the prenatal findings. Microscopic analysis of the tumor tissue showed branching vessels which are typical of hemangiopericytoma. The lesions in our case occurred in association with macrosomia with visceromegaly detected at autopsy, suggesting a possible role of tumor suppressor genes.- - - - - - - - - - ranking = 0.2keywords = macrosomia (Clic here for more details about this article) |
9/20. Severe diabetic fetopathy despite strict metabolic control.In pregnant women, diabetes mellitus (DM) can cause severe complications for both mother and child during pregnancy and delivery; for example, hypertension, pre-eclampsia, macrosomia or intrauterine fetal death. It is therefore essential to achieve good metabolic control in the mother from before conception to the postpartum period. A 35-year-old primipara with type 2 DM presented herself at our outpatient department at 21 weeks of gestation. Until this time her DM had been treated with oral antidiabetic drugs; these were withdrawn and conventional insulin therapy was initiated. Except for the first two weeks after insulin adjustment, blood glucose values were within the required range. Biometric tests performed until week 30 of gestation showed discreet fetal growth. In the week 31, fetal abdominal girth near the 95% limit was observed for the first time; this was soon followed by an explosion-like enlargement of the abdomen along with glycemic values at the lower limit. A cesarean section was performed in week 35 of gestation because of the excessive macrosomia. The female newborn had a birth weight of 4920 g and, one hour after delivery, a blood glucose of 10 mg/dl requiring an intravenous glucose bolus. In addition, the child needed oxygen and also needed both an enteral and a parenteral supply of glucose until day 7 after delivery. Mother and child were discharged from the clinic 19 days postpartum in good general condition. This case illustrates the complexity of treatment of glucose-tolerance disturbances during pregnancy and underlines the importance of fetal monitoring by ultrasound, given that measurement of maternal blood glucose does not always provide sufficient information on the metabolic situation of the fetus.- - - - - - - - - - ranking = 0.4keywords = macrosomia (Clic here for more details about this article) |
10/20. Feto-pelvic disproportion of mimicking placental abruption.An unbooked patient presented with severe eclampsia and sudden onset of abdominal pain, uterine tenderness and fresh vaginal bleeding. Unsuspected macrosomia and multiple congenital fetal malformation were discovered at delivery and a neonate weighing 7.545 kg was delivered. The infant died shortly afterwards.- - - - - - - - - - ranking = 0.2keywords = macrosomia (Clic here for more details about this article) |
| | Next -> |