[Clinical characteristics of 7 patients with gestational diabetes insipidus].

OBJECTIVE: To investigate the clinical feature, treatment and prognosis of both the mother and the fetus with gestational diabetes insipidus. METHODS: A total of 7 cases of gestational diabetes insipidus collected in the First Affiliated Hospital of Wenzhou Medical College, Wenzhou Combination of Traditional Chinese Medicine with Western Medicine Hospital, and Zhejiang Taizhou Hospital from June 1993 to June 2006 were analyzed retrospectively. RESULTS: Seven cases symptoms all characterized by excessive thirst polydipsia and polyuria. The average 24 h urinary output was between 11 L to 13 L and manifested of hypobaricuria. After effective treatment (three cases were treated with 1-deamino-8-D-arginine vasopressin, another three patients were managed with hydrochlorothiazide, and the last one was cured with antisterone), seven patients with gestational diabetes insipidus did not have any severe consequences. Their symptoms of excessive thirst, polyuria, and polydypsia disappeared from 7 days to 3 months after parturition. Urinary volume returned to normal standard of 1000-2000 ml during 24 hours. Specific gravity of urine recovered normally between a range 1.015-1.025 and serum sodium recovered between 135-147 mmol/L. The average duration of illness was 52 days. Eight newborn infants survived. Two of them were sent to neonatal intensive care unit for treatment. One was because of premature delivery caused by antepartum eclampsia, and the other case was one of the twins who had hydronephrosis. The baby of the first case left hospital after 3 weeks' treatment. The latter one's symptom disappeared 2 weeks after delivery. No obvious symptom was discovered among all the babies through follow-up telephone calls 42 days after childbirth. CONCLUSION: Gestational diabetes insipidus is a rare endocrinopathy complicating pregnancy. This disorder is characterized by excessive thirst, polydypsia, polyuria, hypobaric urine and electrolyte disturbances usually manifesting in the third trimester of pregnancy or puerperium. This is a transient syndrome. The first treatment of choice in patients with gestational diabetes insipidus is 1-deamino-8-D-arginine vasopressin and the second-choice is hydrochlorothiazide. Early diagnosis and appropriate management of the disease may reduce the hazard for both the mother and the fetus during perinatal period.

[Perinatal outcomes of 45 pregnant women with pulmonary hypertension complicating congenital heart disease].

OBJECTIVE: To explore the perinatal outcomes of women with pulmonary hypertension complicating congenital heart disease (CHD). METHODS: Clinical data of 45 cases of pregnant women with pulmonary hypertension complicating CHD from Apr 1995 to May 2007 were analyzed and they were divided into three groups: 29 cases of slight group [pulmonary hypertension of 30 mm Hg (1 mm Hg = 0.133 kPa) to 49 mm Hg], 8 cases of moderate group (pulmonary hypertension of 50 mm Hg to 79 mm Hg) and 8 cases of severe group (pulmonary hypertension equal to or higher than 80 mm Hg). The types of CHD, cardiac functional status (New York heart association, NYHA), gestational weeks of pregnancy termination, mode of delivery, pregnancy after CHD operation and outcomes of infants were compared between the groups. RESULTS: (1) The highest incidence of CHD were atrial septal defect and ventricular septal defect (58%, 26/45). The rate of pregnant women after CHD operation was 29% (13/45), they were mainly in slight group and their NYHA class were in I - II. (2) The occurrence rate of NYHA class III - IV was 7 /8 in severe group. The rate of NYHA class I - II was 6/8 in moderate group. The rate of NYHA class I - II was 97% (28/29) in slight group. (3) The rate of term delivery was 93% (27/29), preterm labor 3% (1/29), abortion 3% (1/29), and the birth weight was (3153 +/- 399) g on average in slight group. The rate of term delivery was 5/8, preterm labor occurred in 3 cases in moderate group. The rate of term delivery was 5/8, preterm labor occurred in 2 cases, and iatrogenic abortion in 1 case in severe group. The average birth weight between slight group and moderate or severe group had a significant difference. (4) Caesarean section rate was 78% (35/45) among all patients. The rate of cesarean section delivery was 76% (22/29) in slight group, 6/8 in moderate group, and 7/8 in severe group. (5) The rate of pregnant women who had portent heart failure or heart failure was 24% (11/45), overall maternal mortality was 4% (2/45). CONCLUSIONS: The higher the pulmonary hypertension, the worse the outcome of the mother and fetus; The pregnant women with good heart function after cardiac operation would have a good perinatal outcome. Cesarean section is more suitable for those women.