Prenatal Control Research Articles

Morbimortalidad materno-perinatal en pacientes con infección por VIH, Hospital Simón Bolívar, 2003-2011, Bogotá (Colombia)

<p><strong>Objetivo:</strong> describir la morbilidad y mortalidad materna y perinatal asociadas a la infección por VIH en el Hospital Simón Bolívar entre el año 2003 y el 2011.</p><p><strong>Materiales y métodos:</strong> estudio descriptivo de cohorte histórica. Se incluyeron pacientes gestantes con diagnóstico confirmado de infección por VIH que asistieron al control prenatal y a quienes se les atendió el parto y el puerperio entre enero de 2003 y diciembre de 2011, en el Hospital Simón Bolívar, institución de tercer nivel de complejidad, centro de referencia para pacientes con VIH, ubicado en el noroccidente de Bogotá. Se realizó muestreo consecutivo y se evaluaron las características sociodemográficas y clínicas basales, y la morbilidad materna durante la gestación, al momento del parto o el puerperio, como también la morbilidad perinatal.</p><span>Se realizó análisis descriptivo de la morbilidad por medio de proporciones y análisis exploratorio de la asociación entre el recuento de linfocitos CD4 y la carga viral con los resultados maternos y perinatales.</span><p><strong>Resultados</strong>: un total de 136 pacientes tenían diagnóstico de VIH confirmado en la institución, de estas se obtuvo información completa en 106 (78 %). No hubo ningún caso de muerte materna y se presentaron 2 casos de muerte fetal <em>in utero</em>. Las principales comorbilidades maternas encontradas fueron anemia (18 %), ETS (22,6 %), neumonía (5,7 %) y fiebre puerperal (4,7 %). Las comorbilidades perinatales más frecuentes fueron bajo peso al nacer (21,7 %) y convulsiones (2,8 %). No se encontró asociación entre la carga viral y el recuento CD4 con la morbilidad materna o perinatal.</p><p><strong>Conclusión</strong>: la paciente gestante con infección por VIH presenta en general un ligero aumento de las complicaciones maternas y perinatales. Es importante realizar nuevos estudios en los diferentes grupos poblacionales para poder valorar adecuadamente todas estas asociaciones.</p>

Prenatal Control of Hb Bart’s Disease in Mainland China: Can We Do Better?

The aim of the present study was to report a 3-year experience on the prenatal control of Hb Bart’s (γ4) disease in Mainland China. All pregnancies with fetal Hb Bart’s disease were included from January 2011 to December 2013. The main clinical characteristics of the affected pregnancies were reviewed, including maternal reproductive history, prenatal care in the current pregnancy, the gestation of pregnancy at the time of booking, the gestation at the time of prenatal diagnosis (PND), and the complications associated with the pregnancy. A total of 246 cases of fetal Hb Bart’s disease were identified during the study period; among these, 177 (72.0%) were diagnosed in early gestation (≤24 weeks), and 69 (28.0%) in late gestation. Most (87.0%) of the patients presenting in late pregnancy had late or no prenatal care. Twenty (29.0%) had major obstetrical complications in patients presenting in late pregnancy, and five (5.0%) in patients presenting in relatively early pregnancy. The delay in PND deprived couples of opportunities to make informed decisions early in pregnancy. Efforts for designing and targeting strategies to improve the timeliness of prenatal care are urgently needed.

Evaluación de la disfunción vaginal en mujeres embarazadas sintomáticas y asintomáticas mediante la utilización de los estados vaginales básicos (EVB) y su comparación con el estudio microbiológico convencional

Infections of the lower genital tract associated to maternal and perinatal complications frequently occur during pregnancy. The aim of this study was to evaluate vaginal dysfunction through the analysis of basic vaginal states (BVS) using the methodology of balance of the vaginal content (BAVACO) and to compare it with the microbiological study of candidiasis, trichomoniasis and bacterial vaginosis (BV). Pregnant patients (1238) were examined from 2010 to 2012. In asymptomatic (A) (n: 1046) and symptomatic pregnant women (S) (n: 192) BVS I was 59.5% and 26% of the patients, respectively. BVS II was observed in 19.7% of A and in 17.2% of S. BVS III was only detected in A in 0.4%. BVS IV was observed in 14.4% of A and in 38% of S. BVS V was detected in 6% of A and in 18.8% of S. Yeasts were associated to BVS I and II in 55.5% and 23.2% of A, respectively; and in 32.4% and 31% of S, respectively. Trichomonas were associated to BVS I in 50% of A, to IV in 44.4% of S and to V in 33.3% of S. BAVACO susceptibility to detect yeasts was 80.4% and 85.5% in A and S, respectively; 40% and 75% in A and S, respectively, to detect trichomonas and 100% in A and S to detect BV. BAVACO specificity was 100% for all pathogens in A and S. The study of BVS proved useful as a guide to evaluate vaginal dysfunction, regardless of symptomatology. Therefore, this study is recommended as prenatal control.

Prenatal control of Hb Bart’s hydrops fetalis: a two-year experience at a mainland Chinese hospital

α-Thalassemia is a common inherited disease in southern China. The severest form is Hb Bart’s hydrops fetalis, in which the affected fetuses almost always die in utero or shortly after birth, and the mothers are at high risk for severe morbidity. Therefore, this condition should be controlled, especially prenatally. In this study, we reported on a two-year experience in prenatal control of Hb Bart’s hydrops fetalis at a mainland Chinese hospital. Totally, 573 pregnancies at risk for Hb Bart’s hydrops fetalis were referred and different prenatal procedures were offered depending on the gestational age at presentation. One hundred fifty-two affected fetuses were diagnosed prenatally; among these, only half presented in early gestation, and were terminated in time. Although our prenatal program has successfully prevented the birth of children with severe thalassemia, it does not show a satisfactory outcome, considering the gestational age when an affected pregnancy is terminated.

Screening and Diagnosis of Hb Quong Sze [HBA2: c.377T > C (or HBA1)] in a Prenatal Control Program for Thalassemia

Hb Quong Sze [Hb QS, HBA2: c.377T > C (or HBA1)] is a common nondeletional thalassemia in southern China. It is one of the major alleles causing nondeletional Hb H (β4) disease in the Chinese population. There is no strategy currently in place that aims to screen using hematological index cutoffs for this variant. This study was carried out to evaluate whether it is effective to use mean corpuscular hemoglobin (MCH) <27.0 pg as a screening test in the first step of screening for Hb QS carriers in southern China. The data of hematological testing in the Hb QS carriers obtained from couples who underwent prenatal thalassemia screening, regardless of the red blood cell (RBC) indices, were retrospectively reviewed. A total of 51 Hb QS carriers were identified, giving a prevalence rate of 0.2%; among these, 45 were Hb QS heterozygotes. The values of hemoglobin (Hb), MCV and mean corpuscular Hb (MCH) in the 45 Hb QS heterozygotes were 13.2 ± 1.8 g/dL, 75.2 ± 3.3 fL and 24.5 ± 0.5 pg, respectively. Eight heterozygotes (17.8%) had an MCV value of >80.0 fL, ranging from 80.9 to 84.1 fL, and would not be detected using the cutoff value of MCV <80.0 fL as a criterion for thalassemia screening. However, if screening had been based on the MCH <27.0 pg value, all 45 Hb QS heterozygotes would have been detected. Using a cutoff value of MCH <27.0 pg in nondeletional thalassemia screening would greatly decrease the DNA diagnosis burden.

Prevention and control of Hb Bart's Disease in Guangxi Zhuang Autonomous Region, China

ObjectiveTo demonstrate the performance of Hb Bart's Disease prevention in Guangxi Zhuang Autonomous Region, China. Study designA prenatal control program for Hb Bart's disease was conducted from January 2006 to December 2012. A total of 17,555 pregnant women were screened for α-thalassemia in our prenatal screening program. Pregnancy at-risk for Hb Bart's disease was offered the choice of direct invasive testing or the non-invasive approach with serial ultrasonography. ResultsA total of 1425 at-risk couples attended the prenatal diagnosis. Three hundred ninety couples were screened at our own hospital, and the remaining 1035 couples were referred from other hospitals. Two hundred and three pregnant women chose non-invasive approach, and 1122 chose invasive testing. A total of 365 fetuses were diagnosed with Hb Bart's disease. All cases were finally confirmed by fetal DNA analysis. Eighty-two cases (22.4%) were diagnosed by chorionic villous sampling and 194 (53.2%) by amniocentesis samples. The other 89 (24.4%) cases were performed by cordocentesis. All of the affected pregnancies were terminated. ConclusionImplementation of a prevention and control program accompanying with a referral system for prenatal diagnosis is technically feasible in Guangxi Zhuang Autonomous Region, China.

Colombian Consensus defining the criteria for admission of critically ill pregnant patients to the intensive care unit. A document aimed at reducing variability in the care provided to pregnant women with severe complications

Extreme maternal mortality and morbidity continue to be a serious public health issue in Colombia. In order to address this problem, it is essential to make an early diagnosis of severe pregnancy complications, provide initial management, ensure timely referral of patients with severe preeclampsia, post-partum bleeding, obstetric infection, pulmonary embolism and other pathologies with a poor prognosis when associated with pregnancy, delivery and post-partum, and which require a multidisciplinary approach in critical care units. For this reason, although it is not the policy of Revista Colombiana de Obstetricia y Ginecologia (RCOG) to publish manuscripts already brought to the public by other media, we have decided to publish the Clinical Practice Guidelines for prenatal control and management of partum and post-partum complications, as well as the Guidelines for the syndromic management of genital tract infections published by the Colombian Ministry of Health and Social Protection. The aim is to disseminate the recommendations for the management of pregnant women with severe complications among Obstetrics and Gynaecology specialists, general practitioners, and nurses practicing obstetrics in Colombia. Consequently, this issue of RCOG includes the “Consenso colombiano para la definicion de los criterios de ingreso a unidades de cuidados intensivos en la paciente embarazada criticamente enferma” (Colombian Consensus defining the criteria for admission of critically-ill pregnant women to the intensive care unit). This management guideline was published in September 2013 in Acta Colombiana de Cuidado Intensivo , vol. 13, supl. 5. In this way, we hope to contribute to the reduction of maternal mortality in Colombia.

La gestación en medio de la inseguridad alimentaria: Percepciones de un grupo de adolescentes embarazadas

Describing pregnant adolescents' perceptions regarding food insecurity in their households.Quantitative methodology involving an ethnographic approach was used; seventeen adolescents in their third trimester of pregnancy were included in the study; they were registered in the Medellin public hospital network's prenatal control program and living in households classified as being food insecure.Some adolescents said that initially their pregnancies were unwanted; however, feeling a baby in their wombs became an act of love and became acceptance of their unborn children. Single-parent families headed by women and a background of adolescent pregnancy amongst the participants' mothers were striking findings. Although pregnant adolescents recognized the type of nutrition which should have been consumed according to their physiological period, beliefs and preferences, their financial difficulties and the situation that they lived in limited their access to food, thereby making the most valuable food in nutritional terms become the least consumed by them.Poverty spreads the experience of food insecurity and hunger within a household and generates concern in mothers-to-be about the future of their unborn children's nutrition, feelings of intense pain, helplessness and hopelessness concerning the future.

Morbilidad materna extrema en el Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, 2007-2009

Objetivos: Caracterizar la morbilidad materna extrema (MME) en un Hospital Nacional de Lima. Diseño: Estudio observacional, retrospectivo, de corte transversal. Institución: Hospital Nacional Docente Madre-Niño San Bartolomé. Participantes: Madres gestantes o puérperas. Intervenciones: Se revisó 206 historias clínicas de pacientes atendidas entre enero del 2007 y diciembre del 2009 y que cumplieron alguno de los criterios de inclusión de morbilidad materna extrema relacionados con la enfermedad específica, falla orgánica o manejo. Se analizó las variables sociodemográficas y obstétricas, siguiendo el protocolo establecido en la metodología para la vigilancia de la FLASOG, además de la identificación la causa básica de morbilidad y los retrasos acorde a lo establecido en la metodología de la ‘ruta hacia la vida’. Principales medidas de resultados: Incidencia y características de las pacientes. Resultados: La morbilidad materna extrema (MME) afectó a 0,94% de pacientes del Hospital San Bartolomé, con índice de mortalidad de 0,032, razón de morbilidad materna (MM) de 9,43 y relación MME/MM de 30,43. Estuvo relacionada con edad materna mayor de 35 años, nivel educativo bajo, multiparidad, falta de control prenatal, períodos intergenésicos corto o prolongado, gestaciones pretérmino, terminando la mayor parte en cesáreas, con tasa alta de mortalidad perinatal. La enfermedad hipertensiva de la gestación fue la causa más importante de MME (42,2%), seguida por la hemorragia puerperal (17,5%). Hubo alteración de la coagulación en 33,5%, transfusiones en 27,2% y alteración de la función renal en 26,7%. Los retrasos relacionados con la calidad de la prestación del servicio (tipo IV) fueron los que más se asociaron (58,3%) con la ocurrencia de casos de MME. Conclusiones: La morbilidad materna extrema se presentó en una importante proporción de casos en el Hospital Nacional Docente Madre-Niño San Bartolomé, siendo la causa más frecuente la enfermedad hipertensiva de la gestación. Palabras clave: Morbilidad materna extrema.

Prenatal control of nondeletional α‐thalassemia: first experience in mainland China

To demonstrate the performance of nondeletional α-thalassemia prevention at a mainland Chinese hospital. A prenatal control program for nondeletional hemoglobin H (Hb H) disease was conducted from January 2010 to June 2012. All couples were screened for α-thalassemia trait, and for couples in whom one partner was tested positive for α(0) -thalassemia, the other was subjected to screening for Hb Constant Spring and Hb Quong Sze mutations. Prenatal diagnoses were offered in pregnancies of couples at-risk for nondeletional Hb H disease. Of the 30,152 couples screened, 18 (0.06%) were diagnosed as at risk for nondeletional Hb H disease. There were other 13 at-risk couples who were referred to prenatal diagnosis because they had previously an affected child. Of the 31 cases with prenatal invasive tests, 11 (35.5%) had diagnosis by chorionic villous sampling, and 20 (64.5%) had amniocentesis. Totally, 12 fetuses were diagnosed with nondeletional Hb H disease, and all of the affected pregnancies were terminated. Implementation of a prevention and control program accompanying with a referral system for prenatal diagnosis is technically feasible in southern China, and a number of nondeletional Hb H disease have been prevented during the past 3 years of operation.

Effectiveness of the model for prenatal control of severe thalassemia

The aim of the research was to determine effectiveness of the model for prenatal control in reducing new cases of severe thalassemia. Pregnant women at six tertiary centers were recruited to follow the model, consisting of (1) carrier screening using mean corpuscular volume (for alpha-thal-1 and beta-thal) and CMU-E screen (for HbE trait), (2) carrier diagnosis, (3) the couples at risk were counseled and offered prenatal diagnosis, and (4) termination of affected pregnancy. All neonates were evaluated for thalassemia. Of the 12,874 recruited pregnancies, 7008 were valid for analysis. Of them, 281 couples were identified to be at risk, Of the 281, 58 affected fetuses were identified and 55 pregnancies were terminated, whereas three did not accept pregnancy termination. All 6727 neonates at no risk were proven to be unaffected. The model had sensitivity and positive predictive value of 100% and 20%, respectively. The model could detect all of affected fetuses. The model could prenatally identify affected fetuses with a detection rate and negative predictive value of 100%. The model was highly effective to prenatally detect affected fetuses with an acceptable false positive rate.

Prenatal ethanol exposure does not cause neurological alterations in adult CD1 mice

Genetic factors are involved in variation in fetal alcohol spectrum disorders (FASD), which is also observed among various inbred mouse strains. The CD1 mouse strain is often used in toxicological and genetic experiments. However, there is little literature using this strain to study long-term neurologic abnormalities of FASD. In the present study, we addressed the effect of prenatal ethanol exposure on neurological alterations in adult CD1 mice. The female CD1 mice received exposure to ethanol solution (10 vol%) starting from 2 weeks before mating up to pups born (postnatal day 1). At 24 weeks after the birth, the prenatal ethanol-exposed mice and control mice showed no difference in spatial learning and memory performance in a Morris water maze. Consistently, pathological changes, such as increased neuronal apoptosis, decreased synaptic protein synaptophysin expression, synaptic loss and reactive astrogliosis, were not observed in the hippocampus of mice prenatally exposed to ethanol. These results suggest that CD1 mice are highly resistant to prenatal alcohol exposure and may serve as genetic modification models of FASD.

Ano imperforado. Enfoque clínico-epidemiológico

Introduction. Ano-rectal malformations are among the most common defects in clinical practice. Unfortunately we do not know how many new cases occur each year in our country. The aim of this study is to show a clinical-epidemiological aspect of the problem. Material and methods. It is a retrospective study over a period of three years in which we studied 72 charts. We analyzed universal variables such as sex, age, prenatal control, birth weight etc. There were 42 (58.3%) males, and 30 females (41.8%). Their age ranged from one to eight days, the mean birth weight was 2,827 grams, the average age of parents was 23.4 and 25.3 years. Results. Fourty two (58.3%) patients required colostomy; only 17 had an associated malformation. There were three deaths. Conclusions. Anorectal malformations are severe and common defects. We propose that a national registry should be mandatory.

Влияние пренатального стресса и 17β-эстрадиола на тревожность и депрессивное поведение овариоэктомированных самок крыс

The present study evaluated the ability of 17beta-estradiol to induce anxiolytic- and antidepressant-like action in adult ovariectomized female offspring of dams that were restrained under lights for 1 h on gestational days 15-19. There were no differences in behavioral profile of ovariectomized prenatal stressed and control female rats. Injections of 17beta-estradiol (0.5 microg/rat) in the course of two week had minimal behavioral effects in control rats, but produced a decrease of immobility in the forced swimming test and anxiety level in the elevated plus maze in prenatal stressed rats. These findings suggest that ovariectomized prenatal stressed female rats demonstrate more sensitivity to estrogen-replacement.

Prevalencia de sífilis gestacional e incidencia de sífilis congénita, Cali, Colombia, 2010

Objetivo: determinar la prevalencia de sífilis gestacional e incidencia de sífilis congénita de la ciudad de Cali, Colombia en el año 2010.Materiales y métodos: estudio de corte transversal descriptivo. La población de estudio correspondió a las embarazadas que tuvieron control prenatal y asistieron para la atención de parto en Cali, y cuyo resultado materno y perinatal se conoció. Se excluyeron las pacientes con la ficha epidemiológica mal diligenciada. Se evaluaron las características sociodemográficas clínicas de las gestantes con sífilis gestacional, se estimó la prevalencia de sífilis gestacional e incidencia de sífilis congénita en la ciudad de Cali en el año 2010.Resultados: la prevalencia de sífilis gestacional encontrada fue de 1,4%, la incidencia de sífilis congénita para la ciudad de Cali fue del 2,5 por 1000 nacidos vivos en el año 2010. El 35% de las pacientes con serología positiva son tratadas inadecuadamente.Conclusiones: la prevalencia de sífilis gestacional es mayor a la esperada por la Organización Panamericana de la Salud.

Análisis de costo-efectividad del uso de calcio más ácido linoleico para la prevención de la hipertensión inducida por el embarazo en mujeres con riesgo en Colombia

Objetivo: analizar la costo-efectividad del uso de calcio-ácido linoleico y control prenatal frente a calcio y control prenatal para prevenir hipertensión inducida por el embarazo (HIE) en mujeres con riesgo en Colombia, desde la perspectiva del tercero pagador.Materiales y métodos: en un árbol de decisiones se simuló la historia natural de la enfermedad. Las medidas de resultado fueron la mortalidad materna y perinatal evitadas. Los costos de los medicamentos fueron los promedios del mercado (2010). Los costos directos de atención se tomaron de aseguradores y de registros individuales de las prestaciones de salud.Resultados: la razón de costo-efectividad incremental fue menor en el brazo tratado con calcio-ácido linoleico que en el tratado con calcio para ambos desenlaces ($723.788 por año de vidas salvadas en madres y $103.741 por año de vidas salvadas en hijos frente a $4.709.708 y $2.240.294 para el brazo de solo calcio respectivamente). La comparación entre calcio-ácido linoleico y calcio revela dominancia del primero en términos de costo-efectividad incremental para ambos desenlaces, dado que es más efectivo (0,44 años de vida salvados en madres y 11,84 años de vida salvados en hijos) y menos costoso ($6.676.952) para el caso base. La razón incremental de costo-efectividad entre calcio-ácido linoleico y control prenatal sería a favor del primero tanto en el desenlace materno como perinatal.Conclusión: para Colombia, el uso de calcio-ácido linoleico es el mejor tratamiento en mujeres con riesgo de HIE, frente a calcio o control prenatal, tomando como indicador las muertes maternas y perinatales evitadas.

Body composition and newborn birthweight in pregnancies of adolescent and mature women

Teenage pregnancy has been associated with adverse effects for the mother and the newborn (NB). In order to compare body composition (BC) between adolescents (Ad) and mature women (MW) during pregnancy and to determine the difference in birthweight and perinatal morbidity, pregnant Ad (n=40) and MW (n=227) were studied. BC changes between the second and third trimesters were determined by multifrequency bioelectrical impedance analysis, and birthweight and NB morbidity were evaluated. During the second and third trimesters of the pregnancy, fat mass was lower in the Ad group [16 kg (13-19)] than in the MW group [22 kg (17-27)] (P<0.01; median and quartiles 1-3). Fat-free mass increased by 3.09 kg (2.29-4.20) and 2.20 kg (1.0-3.59) (P≤0.01), and total body water increased by 2.77 L (0.84-4.49) vs. 2.04 L (0.55-3.89) (P=0.36), in the Ad and MW groups, respectively (median and quartiles 1-3). Birthweight was not significantly different between NBs of Ad (3223 ± 399 g) and NBs of MW (3312 ± 427 g, P=0.22). The youngest Ad (<18 year old, n=8) had NB with lower birthweight than MW (3031 ± 503 g, P=0.06). NBs of Ad mothers showed a non-significant trend towards a higher rate of morbidity relative to the NBs of MW. In conclusion, the BC of Ad differs from that of MW during pregnancy. In addition, the NB infants of Ad mothers tended to have a lower birthweight than those from MW, a result that suggests that the Ad should be in strict prenatal control.

Effect of Early Stimulation on Some Immune Parameters in a Model of Prenatally Stressed Rats

The aim of this research was to investigate the effects of prenatal stress and handling on immune system celldistribution and lymphocyte T proliferation in adult Albino Wistar male rats. Prenatal stressed (PS) offspring byimmobilization (IMO) were handled during the first week of life. Animals of both treatments were acute IMOstressed. Blood was extracted from 0 to 330 min, and counting of white blood cells, leucocyte subpopulationsand levels of corticosterone (COR) were made. Lymphocyte T spleen proliferation was determined. COR,leucocyte, lymphocyte and neutrophil profiles and lymphocyte T proliferation were significant different betweenprenatal stress and non-handling group and prenatal control and non-handling group, however these responseswere attenuated when animals were handled. In conclusion, early handling revert the effects of PS withre-exposure to the same postnatal stressor on the activity of hypothalamo-pituitary-adrenal axis, the dynamic ofleucocyte distribution and the mitogenic response of T lymphocytes.

Infección congénita por citomegalovirus: presentación de tres casos y revisión de la literatura

La infección perinatal más frecuente es causada por citomegalovirus (CMV), en el feto y el recién nacido esta infección es la principal causa de sordera y compromiso en el desarrollo psicomotor; el tamizaje, diagnóstico y manejo no se han protocolizado en el control prenatal. El pronóstico de estos pacientes dependerá de un manejo adecuado. Se presentan tres casos con el objetivo de revisar el diagnóstico prenatal y el manejo en el neonato.Materiales y métodos: se muestran tres casos de infección congénita por citomegalovirus diagnosticados en el Hospital Universitario Hernando Moncaleano de Neiva-Huila, centro de referencia de la región suroccidental de Colombia. Se realizó una búsqueda electrónica en las bases de datos de PudMed, Embase, Medline, Lilacs, Cochrane.Resultados: se encontraron 31 artículos, dos guías basadas en evidencia, seis revisiones sistemáticas, dos consensos de la Asociación Española de Pediatría, cuatro estudios de casos y controles, cuatro estudios de cohortes, doce revisiones narrativas, un estudio analítico de decisiones y de costos.Conclusión: el tamizaje rutinario para CMV en el control prenatal no está recomendado. Se debe hacer tamizaje en mujeres gestantes de alto riesgo. El método de tamizaje son la inmunoglobulina IgM específica y el test de avidez por IgG, si esta es baja confirma infección reciente. La prueba confirmatoria es la PCR para CMV. En recién nacidos la prueba de tamizaje es la PCR y el patrón de oro es el cultivo viral. En mujeres con infección gestacional se debe aplicar inmunoglobulina específica para protección fetal.

Specialised fetal and maternal service: Outcome of pre-gestational diabetes

The objective of the study was to determine the outcome of pregnancies with pre-gestational diabetes mellitus (PGDM) in the presence of a specialised maternal and fetal service. Prospective data included mothers with documented pre-gestational diabetes (PGDM) delivered between 1 January 2007 and 31 December 2009. A total of 138 patients with PGDM were included in this study. The post-lunch glucose level at 34 weeks was significantly lower than at 30 weeks’ gestation (p = 0.007) and 37 weeks’ gestation (p = 0.02). No correlation was observed between maternal blood sugar and birth weight. The incidence of pre-term labour, stillbirth and admission to the NICU was similar to the control group. Caesarean section rate was 39.1%, and the main indication was previous caesarean section. The incidence of fetal anomalies was significantly higher than in the control group. It was concluded that the presence of specialised maternal and fetal clinics reduces complications related to prenatal glycaemic control. However, complications related to preconception care remains high.