Shmuel Friedman

Gestational diabetes mellitus. A survey of perinatal complications in the 1980s.

Neonatal morbidity was assessed in the offspring of 878 mothers with gestational diabetes mellitus (GDM), 132 mothers with pre-GDM, and 380 control subjects. Compared with the control group, the GDM group had a higher incidence of complications, including macrosomia, hypoglycemia, hyperbilirubinemia, hypocalcemia, polycythemia, and major congenital anomalies (P < 0.05). Although our GDM patients were stringently managed with diet or diet plus insulin, as indicated, and maintained almost euglycemic values, these neonatal complications could not be eliminated. Our data may be consistent with observations published during the last decade that even subtle degrees of maternal hyperglycemia can have a detrimental effect on perinatal outcome. Most neonatal complications readily respond to therapy if diagnosed and treated early and promptly. Macrosomia can have a detrimental effect on delivery (trauma) and later long-term implications during childhood. Tight metabolic control with diet and, when indicated, insulin treatment may be advantageous in reducing fetal birth weight. Criteria of how tight the metabolic control should be remain to be accurately defined.

Idiopathic transient osteoporosis of the hip in pregnancy

Objective: To study the nature of a condition called transient osteoporosis of the hip (TOH) in pregnancy. Method: Fifty‐three cases of this syndrome of unknown etiology have been reviewed and an additional case has been added. Result and Conclusion: TOH is characterized by hip joint pain during the 3rd trimester of pregnancy and signs of demineralization of the femoral head. The course is benign with recovery shortly after birth. No specific therapy is required except bed rest.

Pregnancy in a homozygous familial hypercholesterolemic patient treated with long-term plasma exchange

We describe the first pregnancy in a homozygous familial hypercholesterolemic woman who started plasma exchange therapy 3 years before she became pregnant. We especially studied the effects of plasma exchange on lipid profile, uteroplacental circulation, and pregnancy course.

Prevalence of minor congenital anomalies in newborns of diabetic mothers

Minor congenital anomalies (MCA) were assessed in the offspring of 802 gestational diabetic mothers, 117 pre-gestational diabetic mothers, and 380 offspring born to normal mothers. The prevalence of infants with MCA ranged between 19.4% and 20.5% in the three groups without any significant difference between them. There was no correlation between the prevalence and type of MCA and the severity of the diabetic state. Neither was there any correlation between the prevalence or type of MCA and the appearance or type of major congenital anomalies.

A case of hepatocellular carcinoma in pregnancy detected by routine screening of maternal alpha-feto-protein

A rare case of hepatocellular carcinoma in a 31‐year‐old woman is reported. The diagnosis was made at 16 weeks of pregnancy when very high levels of alpha‐feto‐protein were found upon routine examination. The pregnancy was terminated and cytostatic therapy was given. The patient died one year later.

Ofloxacin during the Second Trimester of Pregnancy

Ofloxacin can cause retarded ossification and arthropathy in young animals, but there is no published information about its teratogenicity in humans. A 36-year-old woman was treated with ofloxacin 200 mg bid for 6 days during the 19th week of gestation. Ultrasound follow-up of the measurements and structure of the fetal long bones revealed no abnormalities. The neonates physical examination and X-rays of the chest and long bones were normal. Although no teratogenic or toxic effects were observed in this patient, the use of ofloxacin in human pregnancy should only be a clinical consideration until sufficient evidence regarding its safety in the human fetus has been published.

Microalbuminuria : prognostic and therapeutic implications in diabetic and hypertensive pregnancy

Microalbuminuria is defined as urinary excretion of albumin that is persistently above normal, although below the sensitivity of conventional semiquantative test strips. Several studies have reported that Type 1 diabetic patients with microalbuminuria are apparently more likely to develop diabetic nephropathy eventually progressing to renal failure. Microalbuminuria is also a strong predictor of mortality in Type 2 diabetes, and is correlated with increased blood pressure in patients with benign essential hypertension. Radioimmunoassay revealed a significantly higher urinary albumin excretion rate in normal pregnant women in the third trimester of pregnancy, compared to the second and first, and compared to non‐pregnant women. Microalbuminuria was found in 30% of women who had a record of gestational diabetes mellitus. Published results are controversial regarding the assumption that microalbuminuria is an early predictor of pregnancy‐induced hypertensive complications.

Non-traumatic rupture of kidney in pregnancy. Case report and review

During pregnancy, dilatation of the urinary collecting system is very common. Acute hydronephrosis is one of the most common causes of severe flank pain in pregnancy. Severe complications of hydronephrosis of pregnancy, such as pain. renal failure or a ruptured collecting system. occur very occasionally. A rare case of spontaneous rupture treated conservatively is presented.

PLACENTAL HORMONE ACTIVITY AFTER REMOVAL OF THE FETUS IN A CASE OF ADVANCED ABDOMINAL PREGNANCY

THE removal of a living fetus while the placenta remained in place in a case of advanced abdominal pregnancy has permitted us to study some of the endocrinological aspects of placental function. The problems under consideration were whether the presence of a living fetus is essential for the secretion of oestrogens, progesterone and chorionic gonadotrophin, and what are the relative roles of the fetus and the placenta in their production; even more important, is the level of excreted hormones a reliable index of fetal viability.

Group B streptococcus amnionitis with intact membranes associated with quintuplet delivery

Chorioamnionitis is a frequent cause of premature labour and delivery, as well as of maternal and neonatal mortality. Group B streptococcus (GBS) has emerged over the past decade as a common pathogen in the etiology of neonatal sepsis. The case of chorioamnionitis reported here is unusual for three reasons: the premature labour was associated with intact membrane and amniotic fluid infected with GBS; all 5 infants were contaminated with GBS and all infants survived. Chorioamniotitis with intact membranes raises some questions regarding the antepartum use of steroids (potent anti-inflammatory agents), etc. The likelihood of chorioamnionitis in spite of cervical mucus, intact membranes, and the bacteriostatic activity of the amniotic fluid should alert the obstetrician to take special precautions, such as weekly vaginal cultures and appropriate vaginal antimicrobial treatment, in cases of imminent premature delivery.