RESUMO
OBJECTIVE: To evaluate obstetric and neonatal outcomes of patients with type 1 diabetes mellitus (T1DM) and compare multidose injection (MDI) and continuous subcutaneous insulin infusion (CSII). STUDY DESIGN: Retrospective study of 53 pregnant patients with T1DM reaching at least 24th gestational week. RESULTS: Fourteen patients (26.4%) hospitalized for insulin dose regulation. Ten patients had hypertensive diseases. Perinatal mortality occurred in 2 neonates owing to cardiac malformations. Neonatal hypoglycemia, small for gestational age, large for gestational age, and neonatal jaundice were demonstrated in 8, 4, 12 and 19 newborns, respectively. Sixteen newborns were admitted to the NICU for various reasons. Congenital malformations were detected in 7 newborns (6 cardiovascular and 1 central nervous system anomaly). Despite lack of statistical significance, total daily insulin doses were higher in the MDI group than in the CSII group with doses of 62 IU (18-166) and 51 IU (20-114), respectively (p=0.119). Gestational and perinatal outcomes also showed no statistical significance. However, all congenital abnormalities and perinatal deaths occurred in the MDI group. CONCLUSION: T1DM in pregnancy is a challenging problem in terms of having better obstetric and perinatal results. CSII may be used safely instead of MDI in appropriate patients.
RESUMO
OBJECTIVE: Intrauterine device (IUD) is a widely used long-acting contraceptive method; however, the side-effects related to IUD may lead to method discontinuation. The aim of this study is to evaluate the relation between the most common side-effects of IUD use; mainly dysmenorrhea, menorrhaghia, pelvic cramping and the relation of these complications with the position of the IUD device within the cavity and uterine dimensions evaluated by transvaginal ultrasonography. MATERIAL AND METHOD: Two hundred and eighty-four patients who had Cu-T380A IUD insertion at the Family Planning Clinic of a tertiary health center were evaluated at insertion and 6 and 12 weeks after the insertion. Demographic characteristics, medical history, symptoms and findings of the gynecological examination were recorded. Transvaginal ultrasonographic measurement of the uterine dimensions, the distance between the tip of the Cu-IUD and the fundus, myometrium and endometrium were measured to evaluate the displacement of the IUD. The relationship between the symptoms and IUD displacement diagnosed by ultrasonographic examination were investigated. RESULTS: Two hundred and sixty-seven patients were followed-up for 12 weeks as the remaining 16 had partial or complete IUD expulsion. A statistically significantly shorter uterine length was measured in patients who complained of menorrhagia in comparison to the ones without this complaint (54.27 ± 6.11 vs 60.25 ± 10.52 mm, p = 0.02) while uterine length was similar in patients with or without dysmenorrhea at 12 weeks (59.60 ± 10.25 vs 60.33 ± 10.68 mm, p = 0.71). The distances between the tip of the IUD and the endometrium, myometrium and the uterine fundus, were statistically and significantly longer in patients who experienced pelvic cramping at 3rd month, showing a downward movement of the IUD. (Endometrium; 0.29 ± 0.72 vs 0.45 ± 0.35 mm, p = 0.02, Myometrium; 1.25 ± 1.39 vs 2.38 ± 2.26 mm p < 0.05, Fundus; 1.68 ± 2.39 vs 2.92 ± 1.78 mm, p < 0.05). CONCLUSION: A shorter uterine cavity length seems to be a predictor of menorrhagia in patients with Cu-T 380A IUD. Patients experiencing pelvic cramping with IUD are more susceptible for IUD expulsion as the downward movement of IUD is more prominent in these patients.
