Diabetes mellitus with pregnancy Al-Zahraa experience

Eighty pregnant diabetic patients were included in this study. Patients were classified acording to Whites classification and gestational age on admission. Home and hospital management with or without insulin were resorted to, to maintain euglycemia. Maternal and foetal outcome were studied. The effect of parity and time of booking as well as class of diabetes and success of control are presented. Incriminating history was found in 75% of cases. Most obstetric complications occurred in class B diabetes especially in those coming after the 2[nd] trimester. Maternal and perinatal mortality and morbidity were reduced to levels comparable to international standards

Fetal and placental measurements as indicators of control in diabetic pregnacy

Abnormal fetal growth in diabetic pregnancy is associated with increased peri-natal morbidity and mortality. Infant's birth weight reflects the degree of diabetic control. i.e. poor control is associated with large for gestational age [LGA] fetus. The antenatal detection of LGA fetuses is a challenge to the obstetrician managing diabetic pregnancy. Ninety pregnant women were included in this study and classified according to the blood glucose level into 3 groups; 30 normal, 30 with controlled diabetes and 30 with uncontrolled diabetes. They had ultrasonographic measurements of the biparietal diameter [B.P.D.], chest circumference, femur length [FL.], abdominal circumference [A.C.], estimated fetal weight [E.F.W.] and placental thickness together with estimation of the glycosylated haemoglobin [G-HB or Hb-A[ic]] at 38 weeks' gestation. A high degree of correlation was found between the infant's birth weight and the blood glucose level [i.e. the degree of maternal glycemic control] 10% of patients with controlled diabetes [F.B.S.<100 mg/dl.] and 57% of patients with uncontrolled diabetes [F.B.S. > 130 mg/dl.] gave birth to macrosomic babies [>4000 gm]. Similar degree of correlation was also found between the infant. s birth weight and A.C. and E.F.W. measurements but not with B.P.D. and F.L. measurements. Abdominal circumference measurment by ultrasongraphy is the most reliable sonographic parameter for the detection of macrosomia in utero and predicting the degree of maternal glycemic control

Role of chlamydia trachomatis in mucopurulent cervicitis

Endocervical chlamydia trachomatis was found in 4 of 80 women [5 per cent] attending the gynecology and Antenatal Clinic of Al-Zahraa University Hospital with clinical signs of mucopurlent cervicitis. A significant association was clearly demonstrated between infection and young age [P = 0.006], contact with partner with urethritis [P = 0.036]. No such association was demonstrated between infection and other historical correlates as years of intercourse and gravidity. Also a significant association was demonstrated between infection and cervical ectopy [P = 0.015], however, no such association was demonstrated for other cervical examination correlates as erythema, friability, discharge, colour and character and number of polymorphonuclear leukocytes. Finally a significant association was evident between chlamydial infection and the use of oral contraceptive versus the use of intrauterine contraceptive devices "I.U.Ds." [- = 0.026], but not between the use of I.U.Ds. and others [P = 0.533]

Evaluation of the optical density determination of the amniotic fluid in assessing fetal lung maturity

Respiratory distress syndrome [R.D.S.] is the commonest respiratory disorder in the premature infant which accounts for a high incidence of neonatal death. R.D.S. is due to a deficiency of surface active material [surfactant] in the neonatal lung. This surfactant was only reliably assessed by measuring the Lecithin/sphingomyelin ratio [L/S] in the amniotic fluid. Amniotic fluid optical density [O.D.] at 650 nm was reported to be as reliable as L/S in assessing fetal Lung maturity. Fifteen pregnant women of the high risk group between 28 and 34 weeks were studied. L/S ratio and optical density at 650 nm of the amniotic fluid were estimated on all patients before and 48 hrs after 4 intra-muscular injections of betamethazone [6 mg every 12 hrs]. Six patients were delivered within 2 -6 days after the injection, one baby died of R.D.S. and the others survived. The remaining 9 patients passed safely through their pregnancies and delivered at term. Amniotic fluids with O.D. at 650 nm of 0.15 were found to have an L/S ratio over 2 while readings <0.05 corresponded to L/S ratio of about 1.3 and readings between 0.05 and 0.15 corresponded to L/S ration of 1.5. Betamethazone injections raised the O.D. [as well as the L/S ratio] from immature pre treatment values to mature post treatment values in 12 out of the 15 cases studied. O.D. readings at 650 nm is a simple, easy, fast and as reliable as the L/S ratio in deciding fetal lung maturity

Evaluation of the efficacy of ritodrine hydrochloride and magnesium sulphate in suppressing preterm labor

Preterm labor is the comonest cause of perinatal death and neonatal morbidity. It occurs in 5-10% of all births. Attempts to suppress preterm labor by various tocolytic agents have been made in order to prevent these complications. Several drugs were used to achieve tocolysis with various side effects and varying usccess rates. Twenty pregnant patinets with excessive uterine activity at 26 - 37 weeks were studied. Ten of them were given ritodrine hydrochloride [yutopar] and the other ten patients were given magnesium sulphate. Six patients form both groups where the single agent caused serious side effects [ritodrine HCL] or failed to suppress uterine activity [magnessium sulphate], were given both agents simultaneously in modified dosage. Ritodrine HCL suppressed preterm labour in 8 patients [80%] without causing side effects while in the remaining 2 patients [20%] it had to be discontinued due to the intolerable side effects of chest compression, severe chest pain and dyspnea. MgSO[4] succeeded to suppress preterm labour in only 6 patients [60%] and failed in 4 patients [40%].In those 6 failures [2 from the ritodrine group and 4 from the MgSO[4] group] both agents were given simultaneously at a lower dose with successful tocolysis in 83.7% of cases but without complete elimination of the serious cardiovascular side effects of ritodrine. Neither agent caused fetal distress, only mild fetal tachycardia was observed in patients given ritodrine. Pregnancy has continued after suppression of preterm labour for 70.5 days in the ritodrine group, 56.8 days in the MgSO[4] group and 56.9 days in the patients given both together. This study showed that ritodrine HCL is more effective than MgSO[4] in suppressing preterm labour but may cause serious cardiovascular side effects. It is recommended that the two agents should not be used simultaneously and each agent should be used on its own and replaceed by the other agent in cases of failure to suppress preterm labour or development of serious side effects

study of trial of labor and the use of oxytocin in patients with previous caesarean section

Trial of labor with the use of oxytocin in patients with previous lower segment caesarean section has received clinical attention in recent years Recent studies failed to show any increased risk of uterine rupture with its attended maternal and/or perinatal sequelae in such patients. In this study, 60 patients with previous lower segment caesarean section were given a trial of labor, 30 of them received oxytocin augmentation. Successful and safe vaginal delivery was achieved in 73.3% of all the study patients [76.7% for the non oxytocin and 70% for the oxytocin group]. The duration of labor was significantly shorter in the oxytocin than in the non- oxytocin group. There was no difference in perinatal outcome and maternal complications in both groups. It is concluded, therefore, that trial of labor with oxytocin use in property selected patients with previous lower segment caesarean section is a safe procedure and strongly recommended in a well equipped hospital. In the presence of continous monitoring and experienced staff

comparative study of clinical and histopathological response of different modalities of therapy used in the management of IUCD induced menorrhagia

Removal of IUCD as a result of menorrhagic side effects was reported to occur in 8% of IUCD users. In this study, 75 women with Cu. T. 200 for more than 3 months with irregular menstrual bleeding were treated ether by metronidazole [Flagyl], mefenamic acid [Ponstan] ehamsylate [Dicynone] or a combination of these 3 drugs for 3 consecutive cycles. Endometrial biopsy was carried out before and after therapy to identify any possible changes in the histopathological pattern. The use of combined treatment of all the 3 drugs gave the most significant result in reducing the amount but not the duration of the flow in 47.4% of patients