Impaired gestational glucose tolerance. Its effect on placental pathology

The aim of this study was to investigate several macroscopic and microscopic features of placenta in cases with impaired gestational glucose tolerance. Seventy-five gm World Health Organization criteria for the diagnosis of gestational diabetes and impaired gestational glucose tolerance were followed during the period June 1999 through to June 2000, at the Maternity Hospital of Kuwait. Macroscopic and microscopic examinations of 95 placentas were carried out. Sixty-five were from the control patients and 30 were from cases with impaired gestational glucose tolerance. Mean maternal age, maternal weight and parity was significantly higher in the impaired gestational glucose tolerance [IGGT] group compared to the control group. Mean birth weight of the baby was significantly higher in the IGGT group compared to the control group. Mean placental weight and the percentage of the cesarean delivery was higher in the IGGT group but did not reach the level of significance. There was no significant association between the microscopic features of the placenta in the control and IGGT groups. Impaired gestational glucose tolerance is related to increased neonatal and placental weight, which may lead to a higher number of cesarean deliveries, stressing the similarity between impaired gestational glucose tolerance and gestational diabetes mellitus. More stringent criteria may be necessary to define gestational diabetes. Microscopic features of placenta both in the control and IGGT groups did not show any significant difference

Clinical presentation of eclampsia in a maternity hospital, Kuwait

To identify the clinical features of eclampsia at the time of the fit and to study the effects of eclampsia on neonatal outcome. A retrospective study of 101 patients with eclampsia in Al-Sabah Maternity Hospital of Kuwait between 1981 and 1993 was undertaken. Seventy one percent of the mothers presented with antepartum eclampsia. Adverse perinatal outcome was associated with low gestation age, birth weight below 2500g and when the antepartum fit occurred >5 hours before delivery. The perinatal outcome was also adversely affected by fetal gender [male] and proteinuria of 2+ or more. Early onset of pre eclamptic toxemia and eclampsia leading to early intervention are a major determinant to perinatal outcome and prematurity. Prompt timing of the delivery in cases of antepartum fit could help improve the neonatal outcome considerably. It seems that pre eclamptic toxemia is the major risk factor for eclampsia when compared with pregnancy induced hypertension. However, treating all cases of pre-eclampsia toxemia involves giving prophylaxis for more than 5% of all mothers per year. Therefore, one needs to study the details of cases of pre eclamptic toxemia and eclampsia to detect the additive factors. This would help to delineate guidelines and identify patients who need prophylaxis and the appropriate time for intervention