Gestational diabetes mellitus: a risk factor for non-elective cesarean section.

AIM: To assess whether gestational diabetes mellitus (GDM) is associated with non-elective cesarean section. MATERIAL AND METHODS: A retrospective cohort study was conducted at the Department of Obstetrics of a level III hospital. Between January 2004 and November 2007, women admitted in labor or with spontaneous rupture of membranes, at term, and with a singleton cephalic presenting fetus were eligible. From these, 220 women with GDM and 660 glucose-tolerant women, delivered immediately after, were selected. The association between GDM and non-elective cesarean was estimated using modified Poisson regression analysis. Relative risks were adjusted for age, pre-pregnancy body mass index, gestational weight gain, previous cesarean, gestational age at delivery and birthweight. RESULTS: Non-elective cesarean section rate for women with GDM was 19.5% compared to 13.5% for non-diabetic women. The crude relative risk of cesarean section was 1.45 (95% CI 1.04-2.02) for women with GDM. After adjustment for confounders, the association between GDM and non-elective cesarean section remained positive and statistically significant (RR = 1.52; 95% CI 1.06-2.16). No significant differences in cesarean indications were found between the two groups. CONCLUSION: GDM was disclosed as a risk factor for non-elective cesarean section. Knowledge of the condition may have influenced obstetrical practice, favoring cesarean delivery.

[Surgical basic skills: surgical sutures]. / Princípios básicos em cirurgia: fios de sutura.

Given the importance of surgery within the specialty of Obstetrics and Gynecology it is crucial to understand the process of wound healing and the suture available to surgical repair. The selection of the type of suture depends on the tissue and anatomical location. The approximation of wound edges can be made with natural or synthetic suture, mono or multifilament. Three properties of a suture material affect its handling: memory, elasticity and knot strength. Tensile strength, tissue reaction and capability to be absorbed are other important characteristics of the suture material.

Revisiting acrania: same phenotype, different aetiologies.

OBJECTIVE: To evaluate the contribution of prenatal and postmortem examinations in establishing the aetiology of acrania. METHODS: Retrospective evaluation of 14 cases of acrania managed through elective termination of pregnancy. RESULTS: The median maternal age was 30 years (range 18-40) and median gestational age at diagnosis was 13 weeks (range 12-15). One mother had epilepsy and was taking anticonvulsants and another had uncontrolled type II diabetes mellitus. Only 3 women were using folic acid at conception. Chromosomal abnormalities were detected in 3 of 8 cases analyzed. Unilateral anopthalmia, cervical rachischisis, midline facial and limb defects coexisted with acrania in 4 cases. Acrania with craniofacial dysmorphism and asymmetrical finger amputation were observed in a case of amniotic band syndrome. A previous history of anencephaly was documented in 1 case. CONCLUSION: Acrania is a characteristic phenotypic expression of a variety of different aetiologies. Investigation with cytogenetic studies and postmortem are essential to provide a definitive answer. This will provide a better understanding of the underlying aetiology and help establish the recurrence risk for future pregnancies.