Gregory L. Goyert

Gestational diabetes mellitus: metabolic and blood glucose parameters in singleton versus twin pregnancies.

OBJECTIVES This study compared the frequency, glucose tolerance test results, and parameters of blood glucose control in twin and singleton pregnancies associated with gestational diabetes mellitus and carbohydrate intolerance. STUDY DESIGN Twin and singleton pregnancies associated with gestational diabetes mellitus and carbohydrate intolerance were compared as follows: frequency, maternal age, weight, 1-hour screen, glucose tolerance test results, posttreatment blood glucose values, insulin requirement, and insulin dose. Statistical analysis included the chi(2) and Student t tests. RESULTS Gestational diabetes mellitus was increased in twins (7.7% vs 4.1%; P <.05). The maternal weight at first visit was significantly less, and the 3-hour glucose tolerance test value was significantly greater than that for singletons. The other parameters were not different. CONCLUSIONS There is a significant increase in the incidence of gestational diabetes mellitus and disturbance of the 3-hour glucose tolerance test in twin pregnancies. However, insulin requirements were not different, suggesting a mild disturbance of carbohydrate tolerance that was effectively managed by the strategies used to achieve blood glucose control in singletons.

Immediate Delivery Room Repair of Fetal Abdominal Wall Defects

Eighteen patients with a prenatal diagnosis of fetal abdominal wall defect were delivered by cesarean section and repaired either immediately (begun within 15 min, n = 9), or by the traditional (delayed) method (n = 9, average delay = 4.4 h). Neonates repaired immediately had comparable gestational ages and birthweight, however, subjectively had less edematous bowel with less fibrous peel. These fetuses were more likely to be closed primarily (7/9 vs. 4/9), spent less time on a ventilator (8.1 vs. 17.9 days), seemed to be fed sooner (7.6 vs. 17.9 days), and discharged home earlier (14.3 vs. 24.0 days). Our results suggest that for fetuses delivered by cesarean section, early defect repair may reduce bowel edema and fibrous peel formation thus facilitating primary closure, with earlier ventilator weaning, feeding and discharge home.

The genetic implication for preceding generations of the prenatal diagnosis of interrupted aortic arch in association with unsuspected DiGeorge anomaly

We present a case of prenatally diagnosed interrupted aortic arch with a ventricular septal defect in the presence of maternal congenital heart disease, which led to the detection of segmental monosomy of chromosome 22q11.2 in both patients. The implications of detecting a microdeletion and the importance of a multidisciplinary approach to prenatal diagnosis and counseling are discussed.

An evaluation of antenatal fetal acoustic stimulation

Fetal heart rate reactivity was evaluated following acoustic stimulation testing (AST). The AST and NST (non-stress test) were compared with regards to certain adverse perinatal outcome criteria, and in a selected sample of cases, to other surveillance tests. These tests were the oxytocin challenge test (OCT) and biophysical profile (BPP). 479 tests were performed on 240 high-risk patients. The AST significantly increased fetal heart rate reactivity. With regards adverse perinatal outcome criteria, there was no significant difference between the AST and NST in relation to sensitivity, specificity or predictive values. In the 38 patients with both non-reactive NSTs and reactive ASTs, 5 (13.5%) had immediate follow-up surveillance tests (OCTs and/or BPPs) that were non-reassuring and necessitated delivery. In four of the five cases, there was evidence of potential fetal compromise. These preliminary observations suggest that the AST may have evoked reactivity in fetuses with early compromise, and raise concerns about replacing the NST with the AST as a primary screening test of fetal well-being.

Idiopathic Granulomatous Angiitis of the Central Nervous System in Pregnancy: The First Case Report

Idiopathic granulomatous angiitis of the central nervous system (IGANS) is a rare vasculitis primarily affecting the spinal cord and brain not related to any underlying systemic disease. Clinical manifestations range from simple headache to cerebral vascular accidents secondary to vascular occlusion. The management of a pregnancy complicated by multiple risk factors including underlying IGANS is reported. An expectant, empiric approach was adopted and resulted in excellent maternal and neonatal outcomes. The first report of the management of a pregnancy complicated by IGANS is presented. Underlying maternal IGANS may not necessarily represent an indication for pregnancy termination.

Acute iron intoxication in pregnancy: Case report and review of the literature

Limited reports exist regarding acute iron intoxication during pregnancy. The maternal and fetal effects of accidental or deliberate ingestion of large amounts of iron may be catastrophic. A case report of acute iron intoxication, management strategies, and a review of the literature are presented. The cornerstones of effective therapy are aggressive management with emesis induction or gastric lavage, bicarbonate instillation, vigorous intravenous hydration, and chelation therapy with deferoxamine.

Prenatal Identification of a Tetraploid Fetus with fish

The first prenatal diagnosis of a tetraploid fetus via fluorescent in situ hybridization (FISH) technology is reported. FISH analysis of uncultured amniotic fluid cells utilizing probes for chromosomes 13, 21, 18, X, and Y revealed that greater than 65% of hybridized nuclei had four signals. Standard cytogenetic analysis revealed a 92, XXXX karyotype

Diabetic retinopathy in pregnancy: A review

Diabetic retinopathy is the leading cause of blindness between the ages of 24-64 years. The first half of this period corresponds to peak fertility and the childbearing years. The effects of pregnancy on diabetic retinopathy are unclear, but recent studies suggest that pregnancy may be less harmful to the retina of the diabetic subject than was thought previously. Nevertheless, there is reason to believe that at least some women experience a worsening of their retinopathy as a result of pregnancy. Thus, careful ophthalmic evaluation and follow-up are essential for the pregnant woman with diabetes. This should include a minimum of one complete eye examination every trimester and within 3 months postpartum. Color fundus photography and laser treatment are safe, whereas fluorescein angiography, although commonly used to evaluate retinal vascular disease, can usually be avoided during pregnancy.