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Management of diabetes mellitus and pregnancy: A survey of obstetricians and maternal-fetal specialists
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Citations from the Literature
of the prohormone, as well as atrial natriuretic factor, increases with the rise in blood volume associated with a normal pregnancy. The circulating concentrations of both the Cterminus and N-terminus of the atria1 natriuretic factor prohormone increased further in the 48 h after delivery. Because both the C-terminus and N-terminus of the atria1 natriuretic factor prohormone contain diuresis-producing peptides, these results suggest that postpartum diuresis may be mediated by these peptides. Heparin therapy for pregnant women with lupus anticongulant or anticardlolipin antibodies Rosove MH; Tabsh K; Wasserstrum N; Howard P; Hahn BH; Kalunian KC Department of Medicine, University of California, Los Angeles, CA !30024,USA OBSTET GYNECOL 1990,75/4 (630-634) Maternal lupus anticoagulants and anticardiolipin antibodies are associated with a syndrome of recurrent pregnancy loss or preterm birth in live-borns, fetal growth retardation, and placental infarction. Fourteen women with one or more abnormal pregnancy outcomes (total 28 losses, one severely growthretarded premature live-born) and no normal outcomes were treated with full-dose, subcutaneous, twice-daily heparin therapy in subsequent pregnancies. Treatment was started at an estimated gestational age of 10.3 f 4.0 (mean f: SD) weeks (range a-18), in a mean total daily dosage of 24,700 f 7400 units (range lO,OOO-36,000). Fourteen of’ 15 pregnancies resulted in live births at 36.1 f 1.7 weeks (range 33-39). The mean birth weight percentile was 57 * 21 (range lo-90), and Apgar scores were good to excellent. The number of placental infarcts was fewer in treated cases than in previous deliveries. Five fetuses had third-trimester or perinatal problems with no sequelae, four discovered by close maternal-fetal monitoring. There was an increased rate of preterm and cesarean deliveries. Maternal complications of treatment were few and minor, with no hypertension, preeclampsia, or serious drug-related complications. Heparin appears suitable for further investigation in the treatrnent of this obstetric syndrome. Management of diabetes mellitus and pregnancy: A survey of obstetricians and maternal-fetal specialists Landon M.B; Gabbe SC; Sachs L Department of Obstetrics and Gynecology, 1654 Upham Drive, Columbus, OH43210-1228, USA OBSTET GYNECOL 1990,75/4 (635-640) To ascertain current practice trends among obstetricians and maternal-fetal subspecialists regarding the care of pregnancies complicated by diabetes mellitus, a questionnaire was sent to all members of the Society of Perinatal Obstetricians (SPO) and a randomly selected group of American College of Obstetricians and Gynecologists (ACOG) Fellows. A total of 273 of 356 SPO members (77%) and 198 of 504 ACOG Fellows (39070)responded. When divided according to years post-residency (ACOG (a), less than 15 years; ACOG (b), 15 years or more), significant differences in practice patterns were observed for ACOG Fellows. The SPO responses were similar Int J Gynecol Obstet 34
among these subgroups. Despite current ACOG recommendations, most clinicians practice universal screening for gestational diabetes. Significant discrepancies appear to exist between ACOG (b) versus ACOG (a) and SPO with regard to methods of glucose surveillance and the threshold for initiating insulin therapy ingestational diabetes. Intensive fetal surveillance, elective delivery, and high cesarean rates are common in pregnancies complicated by insulin-dependent diabetes mellitus, which is most often managed by a perinatologist or by an obstetrician in consultation with an internist. Few insulindependent patients seek preconceptional care.
Proteinkeatine ratio in random urine specimens for quantitation of proteinuria in preeclampsia Jaschevataky OE; Rosenberg RP; Shalit A; Zonder HB; Grunstein S Department of Obstetrics and Gynecology, Hillel Jaffe Medical Center, Hadera 38100, ISR OBSTET GYNECOL 1990,75/4 (604-606) Protein/creatinine ratio (mg/g) in random urine samples was measured in 35 preeclamptic patients and 70 healthy pregnant women. We found a close correlation between the protein/creatinine ratio in random urine samples and both the 24hour protein excretion and the 24-hour protein/creatinine ratio in the preeclamptic patients. The ratio did not exceed 200 mg/g in any of the 70 healthy pregnant women; therefore, ratios below this value can be considered normal. We conclude that determination of the proteinicreatinine ratio in random urine specimens may be a simple method for quantitation of proteinuria in preeclampsia.
A longitudinal study of respiratory changes in normal human pregnancy with cross-sectional data on subjects with pregnancy-induced hypertension Rees GB; Pipkin FB; Symonds EM; Patrick JM Department of Obstetrics and Gynaecology, University Hospital, Nottingham NG72UH. GBR AM J OBSTET GYNECOL 1990,162/3 (826-830) Respiratory frequency, tidal volume, minute ventilation, oxygen consumption, carbon dioxide production, and endtidal carbon dioxide tension were measured longitudinaily during pregnancy and post partum in 20 normal subjects with a computer-assisted mass spectrometer. Resting tidal volume, minute ventilation, oxygen consumption, and carbon dioxide production increased during pregnancy. End-tidal carbon dioxide tension fell progressively during pregnancy. Respiratory exchange ratio was 0.9 at 36 to 39 weeks gestation and 0.8 at 5 -13 weeks post partum. Respiratory frequency did not change during pregnancy. The increase in minute ventilation is in excess of the increase of carbon dioxide production and the resultant fall in end-tidal carbon dioxide tension reflects a fall in systemic arterial blood carbon dioxide tension. The greater respiratory exchange ratio during late pregnancy as compared with post partum also reflects this hyperventilation during pregnancy. Fourteen subjects with pregnancy-induced hyper-
Citations from the Literature
of the prohormone, as well as atrial natriuretic factor, increases with the rise in blood volume associated with a normal pregnancy. The circulating concentrations of both the Cterminus and N-terminus of the atria1 natriuretic factor prohormone increased further in the 48 h after delivery. Because both the C-terminus and N-terminus of the atria1 natriuretic factor prohormone contain diuresis-producing peptides, these results suggest that postpartum diuresis may be mediated by these peptides. Heparin therapy for pregnant women with lupus anticongulant or anticardlolipin antibodies Rosove MH; Tabsh K; Wasserstrum N; Howard P; Hahn BH; Kalunian KC Department of Medicine, University of California, Los Angeles, CA !30024,USA OBSTET GYNECOL 1990,75/4 (630-634) Maternal lupus anticoagulants and anticardiolipin antibodies are associated with a syndrome of recurrent pregnancy loss or preterm birth in live-borns, fetal growth retardation, and placental infarction. Fourteen women with one or more abnormal pregnancy outcomes (total 28 losses, one severely growthretarded premature live-born) and no normal outcomes were treated with full-dose, subcutaneous, twice-daily heparin therapy in subsequent pregnancies. Treatment was started at an estimated gestational age of 10.3 f 4.0 (mean f: SD) weeks (range a-18), in a mean total daily dosage of 24,700 f 7400 units (range lO,OOO-36,000). Fourteen of’ 15 pregnancies resulted in live births at 36.1 f 1.7 weeks (range 33-39). The mean birth weight percentile was 57 * 21 (range lo-90), and Apgar scores were good to excellent. The number of placental infarcts was fewer in treated cases than in previous deliveries. Five fetuses had third-trimester or perinatal problems with no sequelae, four discovered by close maternal-fetal monitoring. There was an increased rate of preterm and cesarean deliveries. Maternal complications of treatment were few and minor, with no hypertension, preeclampsia, or serious drug-related complications. Heparin appears suitable for further investigation in the treatrnent of this obstetric syndrome. Management of diabetes mellitus and pregnancy: A survey of obstetricians and maternal-fetal specialists Landon M.B; Gabbe SC; Sachs L Department of Obstetrics and Gynecology, 1654 Upham Drive, Columbus, OH43210-1228, USA OBSTET GYNECOL 1990,75/4 (635-640) To ascertain current practice trends among obstetricians and maternal-fetal subspecialists regarding the care of pregnancies complicated by diabetes mellitus, a questionnaire was sent to all members of the Society of Perinatal Obstetricians (SPO) and a randomly selected group of American College of Obstetricians and Gynecologists (ACOG) Fellows. A total of 273 of 356 SPO members (77%) and 198 of 504 ACOG Fellows (39070)responded. When divided according to years post-residency (ACOG (a), less than 15 years; ACOG (b), 15 years or more), significant differences in practice patterns were observed for ACOG Fellows. The SPO responses were similar Int J Gynecol Obstet 34
among these subgroups. Despite current ACOG recommendations, most clinicians practice universal screening for gestational diabetes. Significant discrepancies appear to exist between ACOG (b) versus ACOG (a) and SPO with regard to methods of glucose surveillance and the threshold for initiating insulin therapy ingestational diabetes. Intensive fetal surveillance, elective delivery, and high cesarean rates are common in pregnancies complicated by insulin-dependent diabetes mellitus, which is most often managed by a perinatologist or by an obstetrician in consultation with an internist. Few insulindependent patients seek preconceptional care.
Proteinkeatine ratio in random urine specimens for quantitation of proteinuria in preeclampsia Jaschevataky OE; Rosenberg RP; Shalit A; Zonder HB; Grunstein S Department of Obstetrics and Gynecology, Hillel Jaffe Medical Center, Hadera 38100, ISR OBSTET GYNECOL 1990,75/4 (604-606) Protein/creatinine ratio (mg/g) in random urine samples was measured in 35 preeclamptic patients and 70 healthy pregnant women. We found a close correlation between the protein/creatinine ratio in random urine samples and both the 24hour protein excretion and the 24-hour protein/creatinine ratio in the preeclamptic patients. The ratio did not exceed 200 mg/g in any of the 70 healthy pregnant women; therefore, ratios below this value can be considered normal. We conclude that determination of the proteinicreatinine ratio in random urine specimens may be a simple method for quantitation of proteinuria in preeclampsia.
A longitudinal study of respiratory changes in normal human pregnancy with cross-sectional data on subjects with pregnancy-induced hypertension Rees GB; Pipkin FB; Symonds EM; Patrick JM Department of Obstetrics and Gynaecology, University Hospital, Nottingham NG72UH. GBR AM J OBSTET GYNECOL 1990,162/3 (826-830) Respiratory frequency, tidal volume, minute ventilation, oxygen consumption, carbon dioxide production, and endtidal carbon dioxide tension were measured longitudinaily during pregnancy and post partum in 20 normal subjects with a computer-assisted mass spectrometer. Resting tidal volume, minute ventilation, oxygen consumption, and carbon dioxide production increased during pregnancy. End-tidal carbon dioxide tension fell progressively during pregnancy. Respiratory exchange ratio was 0.9 at 36 to 39 weeks gestation and 0.8 at 5 -13 weeks post partum. Respiratory frequency did not change during pregnancy. The increase in minute ventilation is in excess of the increase of carbon dioxide production and the resultant fall in end-tidal carbon dioxide tension reflects a fall in systemic arterial blood carbon dioxide tension. The greater respiratory exchange ratio during late pregnancy as compared with post partum also reflects this hyperventilation during pregnancy. Fourteen subjects with pregnancy-induced hyper-