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

An increase in fetal and maternal complications has been documented in cases of gestational diabetes, but the glucose levels that predict an increased risk have not been clearly defined. We evaluated the frequency of several neonatal complications (macrosomia, congenital anomalies, perinatal mortality, and prematurity) and maternal complications (toxemia, cesarean section, or both) in relation to glucose tolerance in 249 women in the third trimester of pregnancy. None of the women had previous evidence of diabetes, and all had normal results on an oral glucose-tolerance test, according to accepted criteria. On the basis of their two-hour plasma glucose levels, women were divided into three groups: A (glucose less than 100 mg per deciliter), B (glucose 100 to 119 mg per deciliter), and C (glucose 120 to 164 mg per deciliter). The higher two-hour plasma glucose levels were associated with a significant increase in the incidence of macrosomia (9.9, 15.5, and 27.5 percent in Groups A, B, and C, respectively), congenital abnormalities (0.7, 3.5, and 5.0 percent), and toxemia, cesarean section, or both (19.9, 25.9, and 40.0 percent). A significant correlation between the infant's weight and the mother's two-hour plasma glucose level was also observed. These data indicate that even limited degrees of maternal hyperglycemia, which are currently considered to be within the normal range, may affect the outcome of pregnancy.
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PMID:Relation of glucose tolerance to complications of pregnancy in nondiabetic women. 376 19

In an effort to ascertain important epidemiologic and prognostic risk factors, we analyzed 33 cases of Staphylococcus aureus meningitis occurring over an 8-year period (1976 to 1984). Staphylococcus aureus caused 6% of all bacterial meningitis at our University Hospital. Fifty percent of cases were pediatric and included 7 newborn infants, of whom 71% were either premature or had low birth weight. Major underlying diseases were: central nervous system (CNS) disorders (55%), endocarditis (21%, predominantly intravenous drug abusers), other sites of infection (27%), and prematurity (24%). Fifty-seven percent of patients were bacteremic and 41% of those had concomitant bacteriuria. Hypoglycorrhachia was present in 27% of cases, positive cerebrospinal fluid (CSF) Gram stain in 20%, disseminated intravascular coagulation (DIC) in 19%, and methicillin-resistant organisms in 18%. Cerebrospinal fluid cultures remained positive for a protracted period (mean, 6.7 days) regardless of the presence or absence of a CNS shunt. Overall mortality was 21%. Favorable outcomes were associated with the eventual presence of sterile CSF (15.4% vs. 100% mortality) and the removal of foreign bodies (10% vs. 67% mortality). Mortality was also associated (p less than 0.5) with the presence of diabetes mellitus, age greater than 60, obtundation or coma on presentation, bacteremia, or DIC. Cure correlated (p less than .05) with CNS shunt-associated infections, age less than 1, normal neurologic examinations on presentation, or the absence of DIC or bacteremia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Staphylococcus aureus meningitis: a broad-based epidemiologic study. 382 85

There are benefits to patients and a busy obstetric service if repeat cesarean section operations are performed on a scheduled basis. Optimum management avoids prematurity and reduces the need for amniocentesis. Over a period of 20 months repeat cesarean sections were performed at Tripler Army Medical Center while a protocol with the following elements was used: (1) known last menstrual period; (2) landmarks: positive urine human chorionic gonadotropin test by 6 weeks, Doppler fetal heart tone by 12 weeks, date determination by examination before 10 weeks, fetoscope fetal heart tone by 20 weeks, and date determination by size before 30 weeks; (3) date determination by midtrimester sonogram(s); (4) normal third-trimester glucose screening; (5) biparietal diameter of 9.2 or 9.5 cm before scheduling. With two or more clinical landmarks and one date by sonogram or one landmark and date by two sonograms, elective repeat cesarean section was scheduled at 39 weeks if the biparietal diameter was greater than or equal to 9.2 cm (127). If dates by sonogram were less than dates by last menstrual period but greater than 1 week or if last menstrual period was unknown, dates by sonogram and landmarks corresponding to dates by sonogram were used to electively schedule, with biparietal diameters of 9.2 or 9.5 cm respectively required (28). If protocol criteria were not met or earlier delivery was indicated (e.g., vertical scar or diabetes), amniocentesis was performed (42), except when not possible, advisable, or refused when patients either elected labor (20) or were scheduled if three or more criteria for 40+ weeks were met (18). Of 225 patients (70.5%) scheduled by protocol (173), amniocentesis (34), or medical indication (18), 188 (58.9%) were delivered without labor. In the 147 patients (46.1%) delivered electively by protocol without labor or amniocentesis, there were no cases of respiratory distress syndrome and the mean birth weight was 3517 gm. With early care and better patient compliance nearly all repeat cesarean sections can be safely delivered electively with the use of this protocol.
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PMID:The scheduling of repeat cesarean section operations: prospective management protocol experience. 388 79

Five hundred ninety-three nonstress tests were performed on 41 obstetric patients, at gestational ages ranging from 20 to 40 weeks. Diagnoses included 10 cases of prematurity, six cases of diabetes mellitus, five cases of collagen-vascular disease, five cases of poor obstetric history, three cases of cardiac arrhythmia, and one case each of asthma, polyhydramnios, leukemia, nonimmune fetal hydrops; and eight volunteers were without high-risk factors. All neonates had a 5-minute Apgar score greater than 8; 29 neonates weighed greater than or equal to 2500 gm, 12 weighed less than 2500 gm, and four weighed less than 1500 gm. One neonate died of prematurity, and one was small for gestational age. There were no congenital anomalies. There was a significant difference in the number of reactive nonstress tests and nonreactive nonstress tests between the 20- to 24-week, 24- to 28-week, 28- to 32-week, and 32- to 36-week gestational age groups. The increased incidence of nonreactive nonstress tests at earlier gestational ages may have clinical implications.
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PMID:The relationship of the nonstress test to gestational age. 390 68

Information on 555 Aboriginal births which occurred during 1981 and 1982 was forwarded by midwives to the South Australian perinatal statistics unit. Corresponding information was also supplied for all other births in the state. This information showed that Aboriginal women appear to have a higher fertility rate than do other women, particularly in the teenage years. Aboriginal mothers are very young and have a high parity. They appear to receive little antenatal care and there is a greater tendency for their pregnancies to be complicated by medical conditions, such as anaemia, urinary tract infections, cardiac disorders and diabetes. Post-partum haemorrhages and retained placentas are relatively common, as are genital tract infections after delivery. Aboriginal babies are characterized by low birthweights, low Apgar scores, and prematurity. There is an indication that Aboriginal babies may have a high perinatal mortality rate in the country areas of South Australia. It is intended that this information be used as a baseline for evaluating trends in the health status of Aborigines.
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PMID:Aboriginal pregnancies and births in South Australia, 1981-1982. 405 62

Pediatricians must consider it their duty to ensure that every child born is wanted by helping actively with birth control. Ceylonese people need to believe that the children they have will live to adulthood. A minimum period of 2 1/4-3 years is necessary between babies for the sake of the mother's health. Susceptibility to diabetes increases with parity. Prematurity is more likely the less the interval between pregnancies. Greater intervals lower the possibility of maternal, fetal, infant, and childhood mortality. All medical students, nurses, and paramedical personnel should receive family planning classes and work for a time in a family planning clinic.
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PMID:The importance of the pediatrician in family planning. 541 42

Amniotic fluid glucose values were measured in 285 women with normal and abnormal pregnancies. A progressive decrease in glucose values was observed with advancing gestation. Complications in pregnancy did not influence the amniotic fluid glucose value for the given gestational age. In patients with diabetes, very high levels were found, but these progressively decreased with advancing gestation. Since abnormal conditions in pregnancy, other than diabetes, do not affect the amniotic fluid glucose level, it seems to be a reliable tool in assessing fetal maturity. Values above 15 mg/100 ml rule out term pregnancies and those below 5 mg/100 ml, prematurity.
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PMID:Significance of amniotic fluid glucose in pregnancy. 612 9

Early studies suggest that transient tachypnea of the newborn is a benign disease of uncertain etiology. Consequently, prevention of this complication has not been a primary concern of obstetricians. In this study of amniotic fluid phospholipids, 55 pregnancies in which the neonate developed transient tachypnea were compared to 355 pregnancies after which respiratory distress did not occur. Thirteen neonatal complications and procedures, often associated with prematurity, were significantly increased in the infants who developed transient tachypnea. Potential risk factors for transient tachypnea were examined by stepwise discriminant analysis. Negative amniotic fluid phosphatidylglycerol, prematurity (less than 38 weeks), and 1-minute Apgar score less than 7 all made an independent contribution to the overall characterization of infants at increased risk for transient tachypnea. These findings suggest that mild fetal lung immaturity may be a factor in the pathophysiology of this syndrome, and that the relationship of perinatal factors associated with transient tachypnea of the newborn in previous studies, including maternal diabetes mellitus and cesarean birth, may be partially mediated through a neonatal surfactant deficiency.
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PMID:Transient tachypnea of the newborn: the relationship to preterm delivery and significant neonatal morbidity. 685 31

The authors point out the problems that are raised when a patient with cystic fibrosis becomes pregnant. Pregnancy in a patient with cystic fibrosis is rare but these patients do not seem to have diminished fertility. So it is likely that in the future this combination will increase in frequency. The genetic risk is raised. Heterozygotic subjects are about 3 to 5% of the population and there is a risk of 1 in 4 that heterozygotic parents who already have one child with cystic fibrosis will have a second. The BM test and the sweat test are used to screen for the disease at birth. The pregnancy does not always progress well. The level of prematurity is more than 26% and perinatal mortality is 11%. Furthermore, the birthweight of these children is at the lower limits of normal. Finally, the pregnancy makes the mother's state worse with an increase in her lung signs and change in her respiratory function. On the other hand, diabetes seems to be easily controlled. In conclusion, pregnancy seems to be detrimental for these patients.
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PMID:[Cystic fibrosis and pregnancy]. 711 86

The obstetric data relating to 98 older primiparas (OP) (0.21% of all deliveries) are compared with 100 randomly chosen older multiparas (OM) and 100 young primiparas (YP). Notable differences observed were a higher incidence of toxemia and a greater incidence of uterine myomata in the OP group. No difference was seen in the incidences of diabetes, cardiac disease, and essential hypertension. There was a greater number of preterm deliveries. The frequencies of induction of labor, vacuum extraction, and cesarean section were much greater in the OP group. No difference in postnatal course was detected among the 3 groups. No significant increase in perinatal morbidity was observed, but the incidences of prematurity and perinatal mortality were higher. It seems that the attending obstetrician is much quicker to decide to terminate pregnancy or labor ithe OP group. Except for the need for special attention to prematurity and perinatal mortality, the OP group is not at high risk.
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PMID:The problem of the older primipara. 719 Feb 55


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