Miroslava Gojnic

Sensitivity and specificity of ultrasonography as a screening tool for gestational diabetes mellitus

Objective: To evaluate diagnostic accuracy and efficiency of ultrasound markers of gestational diabetes (GDM) and propose an ultrasound based scoring system suitable for screening (UGDS). Methods: 110 women with singleton pregnancies and established maternal and/or pregnancy related risk factors for GDM were scanned at/or after 24 weeks gestation followed by administration of a 3 hour 100-gram oral glucose tolerance test (oGTT). A number of ultrasound markers were determined/measured, including fetal adipose subcutaneous tissue, asymmetrical macrosomy, cardiac circumference, cardiac width, and interventricular septum thickness, immature appearance of placenta, intensified breathing movements, polyhydramnios and placental thickness. Each ultrasound GDM marker was assigned one point to create the ultrasound gestational diabetes screening score (UGDS). Results: All ultrasound GDM markers were positively correlated to the disease P < 0.0001. The strongest independent predictor of GDM was an immature appearance of placenta (RR 40.1 95% CI 5.9–271.0, P < 0.0001). Receiver operator characteristics (ROC) showed an area under the curve of 95.7% confirming good ability of UGDS to discriminate between positive and negative oGTT. We propose a UGDS score of 4 providing sensitivity of 90.9%, and specificity 89.6%. Conclusions: This study suggests that UGDS is a good predictor of GDM.

The effects of adjuvant insulin therapy among pregnant women with IGT who failed to achieve the desired glycemia levels by diet and moderate physical activity

Objective: Evaluation of adjuvant insulin therapy effects on glycemic control, perinatal outcome and postpuerperal glucose tolerance in impaired glucose tolerance (IGT) pregnant women who failed to achieve desired glycemic control by dietary regime. Methods: A total of 280 participants were classified in two groups: Group A patients continued with dietary regime and Group B patients were treated with adjuvant insulin therapy. Glycemic control was assessed by laboratory and ultrasonograph means. Pregnancy outcomes were evaluated by prevalence of pregnancy induced hypertension (PIH), high birth weight, neonatal hypoglycemia and caesarean section rates. Postpuerperal glucose tolerance was assessed by oral glucose tolerance test (oGTT). Results: All laboratory and ultrasound indicators of glycemic control had significantly lower values in Group B. Group A women were more likely to develop the EPH (Edema, Proteinuria, Hypertension) syndrome, 20% versus 7.86% (p = 0.003). High birth weight occurred more frequently in Group A, but the difference was not significant (p = 0.197). Higher rate of caesarean delivery was in Group A than in Group B, 16.43% versus 26.43% (p = 0.041). The difference in neonatal hypoglycemia was not significant (p = 0.478). Pathological oGTT results were observed in 73 Group A patients and in 15 Group B patients. Conclusion: Lower caesarean section rates and the EPH syndrome incidence are the benefits of adjuvant insulin therapy in IGT patients.

Doppler Ultrasound as an Additional Parameter for the Evaluation of Myomas and the Indication of Myomectomy during Pregnancy

Objective: Pregnancies with myomas are known to have an increased risk for complications such as abruptio placentae, dysfunctional labor, growth of the tumor, necrosis and delivery problems, but prediction is still difficult based on clinical and real-time ultrasound evaluations alone. Methods: We evaluated 15 patients with submucosal, intramural and subserous myomas, respectively. Results: We found that in the submucosal myomas, the resistance index in the spiral and radial arteries decreased from 0.80–0.95 to 0.60–0.75 when choriogonadin and aspirin were given. In 3 cases in whom the resistance index increased before delivery, intrauterine growth retardation and the need for surgical delivery occurred. In 9 cases with intramural myomas, a normal decrease in the resistance indexes was seen, but 6 cases had a sharper drop related to necrosis. In 3 of the 5 cases with myomectomies, there were not only signs of necrosis but also of sarcomatous degenerations on histology. The cases with subserous myomas had no complications and the classical physiologic conversion pattern on Doppler evaluations. Conclusion: We feel that the Doppler results helped us with the management issues and gave insights into the typical pathophysiologic sequences, but the clinical role of Doppler flow analysis in pregnancies with myomas needs to be further evaluated.

Relationship between mid-trimester ultrasound fetal liver length measurements and gestational diabetes mellitus.

The aim of the present study was to investigate the relationship between mid‐trimester ultrasound fetal liver length (FLL) and gestational diabetes mellitus (GDM) in a high‐risk population.

Cerebrovascular diseases during pregnancy and puerperium.

Objective. We have studied 37 women with all forms of cerebrovascular diseases. Our aim was to study the etiology, clinical manifestations and prognosis of such conditions during pregnancy or puerperium. Methods. We analyzed the most common causes of cerebrovascular diseases during the given period. Results. The most common causes of cerebrovascular diseases during pregnancy or puerperium are hematological coagulation disorders, cardio embolism and eclampsia, whereas other causes ara rarer. Conclusions. The incidence of cerebrovascular diseases during pregnancy or puerperium is 11%. Cerebrovascular diseases are more frequent in puerperium than during pregnancy, being 1.8:1. Etiology remains undetermined in 35% of the cases.

Different medicaments in fetus maturation–corticosteroid usage

Objective. The object of work is pointing out the significance of improvement highly risk pregnancies by applying artificial fetal lungs maturation in relation to expected outcomes without adequate therapy. Methods. We analyzed fetal lung maturation by using lecithin and sphingomyelin ratio in embryo fluid received by foam test. We examined successfulness of artificial fetal lungs maturation by applying corticosteroids to the embryo in a group of patients with serious form of growth retardation (group A), then to the mother (group B) and by inducing partial mild form of asphyxia with oxytocin infusion (group C). Results. The success of the method is shown by the success of finished pregnancies. We followed the difference between expected and actual term of delivery. Conclusion. Artificial fetal lungs maturation by applying fetal corticosteroids efficiently increases the creation of lecithin and sphingomyelin and enables life of neonate even in period up to 30th week of gestation.

Relationship between mid-trimester ultrasound fetal liver length measurements and gestational diabetes mellitus 妊娠中期三个月超声测量的胎儿肝脏长度与妊娠期糖尿病之间的关系

The aim of the present study was to investigate the relationship between mid‐trimester ultrasound fetal liver length (FLL) and gestational diabetes mellitus (GDM) in a high‐risk population.

Relationship between mid-trimester ultrasound fetal liver length measurements and gestational diabetes mellitus 妊娠中期三个月超声测量的胎儿肝脏长度与妊娠期糖尿病之间的关系: Fetal liver length predicts GDM

The aim of the present study was to investigate the relationship between mid‐trimester ultrasound fetal liver length (FLL) and gestational diabetes mellitus (GDM) in a high‐risk population.

Acceleration of fetal maturation by oxytocin-produced uterine contraction in pregnancies complicated with gestational diabetes mellitus: a preliminary report.

BACKGROUND Prevention of the permanent sequelae of fetal hyperinsulinemia, namely hypertension and obesity, in infants born to mothers with gestational diabetes mellitus (GDM) has remained unresolved. Efforts to reduce fetal macrosomia by attempting to maintain blood sugar within a certain range have certainly failed. We have tried to eliminate fetal macrosomia by accelerating fetal maturation and delivery before the 36th week. METHODS Acceleration of fetal maturation was achieved by endogenous release of thyrotropin-releasing hormone brought about by periodic fluctuations in fetal oxygenation resulting from oxytocin-produced uterine contractions. Fifteen patients with GDM at 33-35 weeks, six of whom had previously given birth to a macrosomic fetus, agreed to participate in the study. Oxytocin was given for 6 h per day to produce regular contractions. In 13 patients it was given for 5 days, and in two patients for 7 days to reach a lecithin/sphingomyelin (L/S) ratio indicative of fetal maturity. RESULTS Eleven patients delivered vaginally after induction of labor and four delivered by Cesarean section. The mean Apgar score at 5 min was 9.13, and the mean birth weight was 2917 g (range 2100-3400 g). No newborn had respiratory difficulties, although four had short episodes of tachypnea. All were cared for in the regular nursery and all were discharged home with their mothers. CONCLUSION Acceleration of fetal maturation, and delivery between 34 and 36 weeks, appears to be a promising means to reduce or even eliminate the permanent sequelae of fetal hyperinsulinemia in pregnancies complicated by GDM.