Pregnancy outcome of gestational diabetic mothers: experience in a tertiary center

Carbohydrate intolerance is the most common metabolic complication of pregnancy. Gestational Diabetes Mellitus [GDM] poses numerous problems for both mother and fetus. The objectives of this study are to find out the incidence ofgestational diabetes mellitus in pregnant women and their pregnancy outcomes. It was also to discover the risk factors for the admission ofneonates to the Neonatal Intensive Care Unit [NICU]. A hospital-based prospective study performed at King Khalid University hospital [KKUH], where 685 pregnant women who were diagnosed with gestational diabetes mellitus, out of 8000 pregnant women registered between January 2000 - December 2001, were followed and their outcomes studied. The incidence ofgestational diabetes mellitus was found to be 8. 6% [95% C.I: 8. 1, 9.3]. There were 511 [74.6%] spontaneous vertex deliveries, and 148 [21.6%] were delivered by lower segment cesarean section. Maternal morbidity in these women was 1.2%.A total of 697 babies were delivered by these 685 women, out of whom 675 were singleton pregnancies, 9 sets of twins and one set of quadruplets. Six-hundred-eighty-seven babies were born alive, 7 babies died in utero and 3 died in the neonatal period. The incidence of neonatal intensive care admission was 4.9%. The mean length of stay in the NICU was 16 days. The commonest cause of neonatal NICU admission was hyperbilirubinemia [41.2%]. The risk factors for NICU admission were delivery bynon SVD procedure [RR: 4.6, 95% C.I: 2. 8, 7.7], preterm deliveries, [RR: 4.6, 95% C.I.:2.7, 7.7], and induction of labor [RR: 2.5, 95% C.I: 1.4, 4.5]. The observation and quantification of maternal outcomes with gestational diabetes mellitus are necessary, so that proper measures could be taken to reduce complications during delivery and the neonatal period and thereby, minimize particularly NICU admission rate

Multiple pregnancy and preterm labor

Multiple gestations are high risk pregnancies, which may be complicated by pre-maturity, low birth weight infants, pre-eclampsia, anemia, postpartum hemorrhage, intrauterine growth restriction, neonatal morbidity and high perinatal, neonatal and infant mortality. This study was carried out to determine the incidence and effect of multiple pregnancies on pre-term labor in tertiary care hospitals. Retrospective case record analysis of 375 cases of multiple pregnancies that were reported at Armed Forces Hospital and King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January 2000 and December 2001. The data was analyzed to determine the incidence of multiple pregnancies and its effect on pre-term delivery. The over whole incidence of twins was 14/1000 births. Premature labor in multiple pregnancies was 7 times greater than singletons [42% versus 6.4%]. Almost half of multiple pregnancy cases were delivered by cesarean section [49% versus 14%]. Pregnancy was induced in 34% of cases. Cervical cerclage was applied in only 8% of cases and betamemetics were administered to only 11% of cases. Fetal distress in labor, abnormal presentation and previous uterine scar were the main indications for cesarean section. Fifty percent had no antenatal complications, gestational diabetes complicated 16%, and anemia was reported in 22% of cases. Preterm delivery remains the most serious complication of multiple pregnancies. Multiple gestation children may suffer long term sequel of prenatal complications, including cerebral palsy and hearing disabilities. Every effort should be made to reduce the risk of multiple gestation and pre-term labor through proper control and close monitoring of fertility drugs, limiting number of embryo transfer to maximum of 3 or only 2, improving the socioeconomic status of expectant mothers, reduce cigarette smoking, relieve maternal stress, restriction of maternal activity, frequent contact with health care personnel and treatment of any obstetric or medical disorders

Uterine didelphus with obstructed hemivagina

Complex congenital anomalies of the mullerian ducts can occur in isolation or in association with other developmental disorders. They result from non-development or non-fusion of the mullerian ducts or the failure of reabsorption of the uterine septum. Early diagnosis is necessary to relieve symptoms, optimize preservation of the genital organs and prevent the development of endometriosis. We present a case report to highlight this phenomenon