Outpatient obstetric management of women with type I diabetes.

Conventional obstetric management of diabetic women has frequently incurred extensive hospitalization. Although this approach improved perinatal results for these women and their infants, it is costly and cumbersome. The 3-year experience of an outpatient diabetic obstetric clinic is compared with the results obtained at the same facility during 5 previous years when hospitalization was used more extensively. Perinatal mortality and morbidity were not different in 51 type I diabetic women managed almost entirely as outpatients when compared with 58 similarly complicated diabetic patients receiving more conventional management. Mean prenatal admissions (1 vs 2, p = less than 0.01), mean prenatal hospital days (6 vs 12, p = 0.05), and prolonged delivery admissions of greater than 7 days (31% vs 69%, p = less than 0.01) were significantly less. Outpatient obstetric management of diabetic women efficiently decreases maternal morbidity without increasing infant morbidity and mortality.

Early versus late tocolytic treatment for preterm premature membrane rupture.

The effect of tocolytic therapy before labor was evaluated in 33 pregnant women with preterm premature rupture of the membranes. Either intravenous magnesium sulfate or oral terbutaline was administered at the time of presentation. Intensive surveillance to detect signs of infection was carried out for all patients. In 29 of the patients in this treatment group who were seen at less than 34 weeks, a significantly longer prolongation of pregnancy was achieved when compared with 24 similar women treated after onset of labor in the hospital (169 hours versus 77 hours, p = 0.05). Duration of infant hospitalization was less for those mothers receiving tocolytic agents before labor. Maternal and infant infection were not different in the two groups; nor was the cesarean section rate. When this treatment group was compared with another control group of 96 women already in labor at presentation, the difference in time from admission to delivery was substantial, but it did not achieve statistical significance. In this group the rate of maternal infection was significantly higher, but newborn morbidity was not. Aggressive early treatment with tocolytic agents in pregnant women with preterm premature membrane rupture is more productive but not more dangerous than conservative management.