Impact of gestational diabetes on lipid profiling and indices of oxidative stress in maternal and cord plasma

To study the effect of gestational diabetes mellitus [GDM] on indices of oxidative stress and lipid profiles in maternal and cord blood samples. Blood samples were collected from 40 normal pregnant women and 46 women with GDM during the period 1998 through to 1999 at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia. The GDM patients were subdivided into 2 groups: patients receiving insulin treatment [GDM-I, N=19] and patients under control diet [GDM-D, N=27]. Plasma a- and y-tocopherols were estimated by high-performance liquid chromatography, whereas malondialdehyde [MDA] was analyzed by fluorometry. Serum lipids [low density lipoprotein, high density lipoprotein, total cholesterol, triglycerides, and total lipids] were determined by enzymatic colorimetry using automated clinical analyzer. The results of lipid profiles in maternal serum showed no significant difference between GDM patients and controls; however, all the lipid constituents except total cholesterol were significantly reduced in the cord blood of GDM patients as compared to control subjects. a-tocopherol levels in the maternal plasma were not significantly different among the 3 groups, whereas, cord plasma a-tocopherol was significantly decreased in both GDM-D and GDM-I. Maternal y-tocopherol was found to be significantly increased in GDM-D and only insignificantly increased in GDM-I, but the cord y-tocopherol showed no appreciable changes. The level of MDA was 3-fold higher in maternal plasma as compared to cord plasma. However, neither the maternal plasma nor cord plasma showed significant differences in MDA levels between GDM patients and normal pregnant women. A significant depletion of a-tocopherol in the cord blood of GDM patients is indicative of a possible oxidative stress in their fetuses. Further studies are warranted to examine a wider range of biochemical parameters to evaluate the potential risks of oxidative damage

Cesarean delivery of the second twin after vaginal delivery of the first twin

To study the effect of cesarean section of the second twin after vaginal delivery of the first twin, and to compare the outcome with twins delivered by cesarean section or vaginally during the same period of time. Data of all women who gave birth to twins at the Armed Forces Hospital, Riyadh, Saudi Arabia, between 1st January 1987 and 31st December 1996 were reviewed. Twin deliveries, where the first twin was delivered vaginally and a cesarean section was carried out for the second twin, were selected. There were 598 sets of twin deliveries during a 10 year study period. Of the 137 emergency cesarean sections for twin pregnancies, 15 [11%] were carried out for the second twin. There were no early neonatal deaths amongst these cases. Following the vaginal delivery of the first twin, every attempt should be made for internal podalic version and breech extraction of the second twin in cases of transverse lie, compound presentation or high cephalic presentation. Forceps or vacuum delivery should be considered for engaged cephalic presentation. Discrepant growth between twins should be identified and the need for cesarean section for the second twin for a very large baby should be eliminated. Elective cesarean section should be considered in these cases. However, whenever indications exist, cesarean section can be performed safely for the delivery of the second twin even after vaginal delivery of the first twin