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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In 901 pregnancies between 1978-1981 a total of 5281 serum estriol determinations were performed. 596 gravidas were high-risk patients (diabetes mell., toxemia, IUGR, premature labour, prolonged pregnancy, Rh incompatibility). In 142 of these high-risk pregnancies the estriol values were below the 10th percentile or the estriol decrease extended 40%. These cases were analysed individually, in order to answer the question, how often serum estriol values were decisive for active obstetrical management. Our data show that a drop of estriol over 40% was very rare (0.53%). For the newborn such an estriol-drop does not mean higher perinatal morbidity or mortality in any case. The endocrine parameters were not very often decisive for an active obstetrical intervention. Probably because of the large fluctuations and day-to-day-variations of the estriol values mainly due to drugs which were widely used in risk pregnancies. These exogenous factors had a negative effect on the clinical value of the serum estriol determinations.
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PMID:[Critical analysis of fetal risk recognition by serum estriol determination]. 668 42

Our study of 390 patients enrolled in a birthing suite program revealed that antepartum or intrapartum problems allowed only 160 (41%) to actually give birth in the birthing suite. Antepartum complications included premature labor in ten (2.5%), premature ruptured membranes in 31 (8%), postdatism in 50 (13%), preeclampsia in 27 (7%), and diabetes mellitus in five (1.3%). Intrapartum complications included meconium in 62 (16%), arrest of labor in 64 (16%), oxytocin use in 85 (22%), and fetal heart rate decelerations in 28 (7%). Two hundred ninety-seven births (76%) were spontaneous. Forty-two low-forceps deliveries (10%), 12 mid-forceps deliveries (3%), and 39 cesarean sections (10%) were done in the traditional labor and delivery suite. Puerperal complications included one uterine inversion, two cases of placenta accreta, one rectovaginal fistula, and two requirements of blood transfusion. Neonatal morbidity included 22 low Apgar scores (7%), two shoulder dystocia, three cytomegalovirus infestations, and one lethal anomaly. Six infants had meconium aspiration, two with severe hypoxia. Any of these complications would overwhelm the patient in home birth. Intense prenatal screening may decrease some risk factors, but the intrapartum period was found to pose unacceptable risks for home birth in this population.
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PMID:Home birth: negative implications derived from a hospital-based birthing suite. 682 92

In normal pregnancies the determination of the L/S ratio permits a reliable ante-partum evaluation of fetal maturity. Good correlation between ante-partum determination and the condition of the newborn is obtained. In the 566 L/S ratios obtained from abnormal pregnancies the method was also reliable. There was 217 Rh incompatabilities, 51 pre-eclampsias, 31 diabetic patients, 112 premature labours, 78 placental insufficiencies and 77 premature ruptures of the membranes. In patients with diabetes the ante-partum diagnosis of pulmonary maturity is doubtful. In some patients with diabetes pulmonary maturity appears to be delayed. A difference between the abnormal pregnancies was not recognized. In the different types of high risk pregnancies no acceleration or retardation of pulmonary maturity was detected with statistical significance. However, in some cases of premature rupture of the membranes, premature labour and placental insufficiency, pulmonary maturity appears to be accelerated.
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PMID:[The antepartum evaluation of pulmonary maturity in high risk pregnancies (author's transl)]. 690 59

Since the introduction of an ultrasound screening program for every pregnancy in Western Germany the importance of these examinations has grown. The first examination between 16 and 20 weeks--for "Dating"--represents the basic tool to avoid fetal hazards in case of premature labour or over term as well as the demonstration of multiple pregnancies and the exclusion of malformations. The second examination between 32 and 36 weeks has to regard the fetal development and the final placental localization. Abnormal fetal growth--i.e. Small for Gestational Age, Diabetes and RH-incompatibility should be recognized. Together with other clinical parameters the best results in the detection of fetal hazard can be obtained if beside good equipment the quality of the examiner and the examination can be guaranteed.
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PMID:[The role of ultrasound in the diagnostics of fetal hazards (author's transl)]. 719 21

The pregnancies achieved up to April 1994 among 162 recipients who participated in our oocyte donation programme were studied. Of these, 113 were > 45 years old and 49 were < 45 years old (25-44); approximately 300 women were not admitted to our programme for various reasons. The 113 recipients considered in this study were divided into two age groups: group A, 45-49 years old (54 patient cycles); and group B, 50-60 years old (58 patient cycles); there was also one case of a 63 year old woman. Overall, 44 clinical pregnancies were established in 113 recipient cycles (38.9%) and 44 healthy babies have been delivered; 10 babies were lost (eight miscarriages, one abruptio placentae and one severe gestational proteinuria hypertension at 25 weeks). There was also one case of medium hypertension (at 32 weeks) and four cases of mild hypertension (30, 32, 33 and 35 weeks). There were no cases of maternal diabetes among the pregnant women due to the strict selection criteria. There were no maternal deaths associated with these pregnancies. Regarding neonatal morbidity and mortality, there was one premature labour in the 31st week in a 53 year old woman because of an accidental fall in an airport, and another one in a 51 year old woman in the 25th week. The remaining babies had good Apgar scores and good weights. There were no child deaths and to date there have been no reports of fetal malformation. All babies delivered are in good health.2
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PMID:Fetal and maternal morbidity and mortality in menopausal women aged 45-63 years. 776 80

The effectiveness of the tocolytic agent and other betamimetic drugs in the treatment of preterm labor remains controversial. Effectiveness or efficancy of ritodrine has not yet convincingly been proven. A major concern are the marked side effects of beta-mimetics. The calcium channel blocker nifedipine has been used for tocolysis shortly after its introduction in clinical practice and is considered to be a probable good alternative for ritodrine. The efficacy of nifedipine versus ritodrine in the treatment of preterm labor was assessed in a retrospective study. 32 patients received intravenous ritodrine and 29 oral nifedipine. As endpoints were used: postponement of delivery, maternal side effects and perinatal outcome. The results of this retrospective study suggest that nifedipine is more successful in postponing delivery than ritodrine. Maternal side effects seemed to occur more frequently and be more serious in patients treated with ritodrine as compared to nifedipine. Perinatal outcome seemed better in the nifedipine group than in the ritodrine group. The promising data from small prospective studies and the results of this retrospective study warrant further large prospective studies on the definitive place of nifedipine in the treatment of premature labor. Until the results of such a trial are available we advocate the use of nifedipine in case of preterm labor, especially in a patient with diabetes mellitus, ruptured membranes, cardiac disease or multiple pregnancy, in order to avoid the characteristic side effects of beta-mimetics.
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PMID:Ritodrine and nifedipine as tocolytic agents: a preliminary comparison. 860 48

Between 1988-1922, data of the nutritional status of pregnant women seen in the Santiago Metropolitan Health Service were analyzed. Underweight (22.2%), normal weight (47.2%), overweight (19.7%) and Obese (15.4%). Four thousand five hundred fifty five pregnant women were studied. Underweight 1136, normal weight 1219, overweight 1100 and obese 1100. Underweight was significantly more frequent in the patients less than 20 years old while overweight and obese was significantly more frequent in the patients over 30 years old. Hypertension (2.6%) was the only significant morbidity factor in the obese group. The overweight and obese groups had earlier menarche, while the obese group had shorter periods. The obese group were associated most frequently with higher parity (75.1%), stillbirth (4.6%), spontaneous abortion (19.5%), induced abortion (3.1%) and high obstetric risk (33.2%). In the normogram used, the underweight patients are abnormally represented at the start of pregnancy. The obese group gained less weight proportionally during pregnancy (overweight and obese 42.8%, underweight and normal 34.7%). The obese group presented more frequently with hypertension (20.4%) and diabetes (0.7%), while the obstetric complications occurred more frequently in the underweight (6.3%). The underwent group had more anemia (45.4%) and premature labor (12.3%). Cesarean section was performed more frequently in the obese group (33.1% versus 21.3% of all the other groups combined. The neonatal birthweight was in direct proportion to the maternal weight, measured by various methods. It is worth noting the importance of microelements in the milk ingestion of the pregnant patients and the influence on their weight.
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PMID:[Influence of body weight in pregnancy and the perinatal results]. 872 43

Preterm labor, cervical cerclage (especially when performed as an emergency procedure), and diabetes mellitus are all associated with an increased risk of chorioamnionitis. It might be expected that the combination of all 3 could lead to especially severe infection. We report such a case. A woman with a history of two spontaneous midtrimester abortions had had cervical cerclage performed at 13 weeks. She was referred at 24 weeks' gestation with preterm labor, and the cervix was found to be dilated. An emergency repeat cerclage was performed. The following day, ultrasonography revealed the presence of intra-amniotic gas. Infection was confirmed by the presence of a purulent cervical discharge, a neutrophilia with a left shift, and an elevated C-reactive protein level. The cervical stitch was removed and labor induced. The infant was liveborn, but succumbed to the complications of prematurity and sepsis. E. coli was isolated. In her subsequent pregnancy, severe gestational diabetes was diagnosed and following pregnancy, permanent diabetes mellitus was confirmed. The combination of infection, diabetes, and intact membranes may lead to a particularly severe form of chorioamnionitis, with the production of gas within the amniotic cavity. Infection should be excluded before emergency cervical cerclage, especially in the woman with diabetes mellitus.
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PMID:Emphysematous chorioamnionitis diagnosed by ultrasonography. 925 46

From January 1982-December 1986, researchers reviewed 1130 patients who had 7 or more viable pregnancies at the University Teaching Hospital in Al-Khobar, Saudi Arabia. The majority of the patients (90%) received regular prenatal care and most of the remaining patients attended a prenatal clinic 3-4 times. For the grand multipara, the rate of spontaneous abortion was higher (24%) compared to total deliveries (13%) in that hospital during the study period. Anemia was the leading predelivery complication for the study group (16.6% vs. 3.5% for total deliveries). Preeclampsia followed as the 2nd leading complication (6.1% vs. 5.2% for total deliveries). In 1 case a 45 year old gravida 13 had eclampsia, and both mother and infant survived. Antepartum hemorrhage occurred in 5.8% of the multiparous women (2.3% for total deliveries) due to abruptio placentae in 43 patients and placenta previa in 34 others. 5.6% of the multiparous patients (1.2% for total deliveries) experienced unstable lie, while successful induction of labor at term occurred in 60% of these women. Diabetes mellitus caused the least predelivery complications (4.8% vs. 2.8%). 73.3% of all deliveries to grand multiparous women resulted in normal deliveries. Delivery complications were higher for the study group, however, than for total deliveries: breech deliveries, 7% vs. 2.7%; premature labor, 7.5% vs. 2.7; cesarean section, 11.4% vs. 8.9%; and postpartum hemorrhage. 6.5% vs. 3.1%. The perinatal mortality rate of 62/1000 for the grand multiparous women was 3 times the overall rate for the hospital (21/1000). Stillbirt accounted for 50% of perinatal deaths for the remaining deliveries. 1 maternal death occurred among the grand multigravida.
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PMID:Obstetric problems in the grand multipara: a clinical study of 1330 cases. 1231 19

Preterm labour is a major cause of neonatal morbidity and mortality but the pathophysiology that underlies preterm labour is unknown. Inositolphosphoglycans (IPGs) comprise a ubiquitous family of putative carbohydrate second messengers and they have been linked to the pathogenesis of various conditions, including diabetes and pre-eclampsia. Studying IPG-P levels in normal and pre-eclamptic pregnancies, we noticed a constant rise of urinary IPG-P levels in all women at the time of delivery. A prospective pilot study of urinary IPG-P levels in 23 non-labouring and labouring women with uncomplicated pregnancies has, therefore, been performed. Levels of urinary IPG-P were significantly higher in labour than in the non-labouring group (P<0.0001). These higher levels have been found in both spontaneous and induced labour. The clinical significance of this observation with particular reference to the onset of labour itself is discussed.
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PMID:Possible involvement of inositol phosphoglycan-P in human parturition. 1289 28


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