Ultrasonic morphological characteristics of yolk sac in pregnancy complicated with type-1 diabetes mellitus.

BACKGROUND/AIMS: In pregnancy complicated with type-1 diabetes mellitus (DM), information on the predictive value of yolk sac (YS) measurement and YS morphology on outcome has been scant. The aim of this study was to compare the size and shape of the YS using transvaginal sonography (TVS) in normal pregnancies and those complicated with well-regulated type-1 DM. METHODS: Sixty healthy pregnant women and 60 pregnant women with type-1 DM underwent TVS. The correlation coefficients between YS and gestational age (GA), YS and crown-rump length (CRL), and YS and human chorionic gonadotropin (HCG) were calculated. Statistical analysis showed that the difference between the YS diameters for each gestational week among the groups studied was highly statistically significant. Statistical analysis of the results was performed with SPSS 10 software. RESULTS: A highly statistically positive correlation was found between YS diameter and GA, CRL and HCG levels for both groups studied. The YS diameter in type-1 DM pregnancies was statistically significantly larger for GA than that of healthy pregnant women. The YS diameter in type-1 DM women was statistically significantly larger after 6 weeks of gestation and the HbA1c levels were >6% when compared to the YS dimensions in the group with HbA1c concentrations of <6%. CONCLUSION: A gross change in YS size may indicate or reflect significant dysfunction of the maternofetal transport system in early pregnancy which is complicated with type-1 DM.

Birth weight of healthy newborns in Zagreb area, Croatia.

The aim of this study was to assess birth weight of healthy newborns from the City of Zagreb and Zagreb County, Croatia. Birth weights of healthy newborns, born at the Department of Obstetrics and Gynecology, University Hospital Center "Zagreb" in the year 2001, were included into analysis. Since there were only few newborns in the 22nd-27th week of gestation, they were excluded from the study. Small number of data points was also noticed in 28th-36th week of gestation, and was supplemented with the data from the years 2000, 2002 and 2003. The method of analysis used in this study was described by Altman and Chitty (Br. J. Obstet. Gynaecol., 101 (1994) 29). After the application of well defined exclusion criteria, the final sample consisted of 4252 newborns. Percentile values for the four groups of newborns (male gender-primipara, male gender-multipara, female gender-primipara, female gender-multipara) were defined, yielding highest birth weight values in the male gender-multipara group (50th percentile of 40th gestational week was 3551.3 g), while female gender-primipara newborns were the lightest among the four sub-samples studied (50th percentile of 40th gestational week was 3399.9 g). New percentile values for percentile curves plotting are presented here and recommended for use in the clinical practice.

Splenic rupture in pregnancy--traumatic or spontaneous event?

Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed occurrence. Failure to recognise it is common, and can be fatal for both mother and child. With all our highly developed diagnostic methods and equipment, aetiology of splenic ruptures in pregnancy remains a dilemma in many cases.

[Cardiovascular neuropathy in pregnant women with type 1 diabetes]. / Kardiovaskularna neuropatija u trudnica s dijabetesom tipa 1.

OBJECTIVE: Autonomic neuropathy has recently been recognized as a potential risk factor in pregnancy of type 1 diabetics. The aim of the study was to highlight this poorly recognized problem in the obstetric management of diabetic mothers. STUDY DESIGN: 94 pregnant type 1 diabetics aged 20-35 with a minimum five--year duration of diabetes. A normal population, i.e. 46 age-matched pregnant women without diabetes were evaluated, because there are no normal values for this population. Cardiovascular tests and structured clinical examination were performed on 3 occasions 3 times during pregnancy (once in each trimester). Cardiovascular tests were performed using the ProSciCard system. A full test battery were performed and six basic tests were evaluated. HbA1c was used to assess diabetes control. Diabetic polyneuropathy was clinically assessed by Dyck's staging system. RESULTS: The incidence of moderate and severe autonomic neuropathy in type-1 diabetic pregnant women was 8.5%. There was no increase in the perinatal morbidity and mortality associated with moderate and severe autonomic neuropathy. CONCLUSION: The presence of moderate to severe symptomatic autonomic neuropathy in patients with type-1 diabetes is not a contraindication for pregnancy. If pregnancy is achieved, the patients should be monitored for the occurrence of pernicious vomiting.