Weak giants

2021 ◽  
pp. 305-310
Author(s):  
Michael Obladen
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
20Th Century ◽  
Death Rate ◽  
Neonatal Death ◽  
Birth Asphyxia ◽  
Maternal Diabetes ◽  
Fetal Mortality ◽  
Hyaline Membranes

Nearly 2% of all pregnancies nowadays are complicated by maternal pregestational or gestational diabetes. Long before diabetic fetopathy was acknowledged, macrosomia was dreaded by obstetricians because of the trauma risk and the need for mutilating operations. Diabetic fetopathy was described and maternal glucosuria quantified by Henrich Bennewitz in 1824. However, most authors ignored his findings and well into the 20th century, series of ‘giant babies’ were published without even mentioning diabetes mellitus. When insulin became available in 1923, maternal but not fetal mortality decreased. In 1952, Priscilla White classified six forms of maternal diabetes during pregnancy and reported an overall intrauterine, intrapartum, and neonatal death rate of 45%. But not all those infants died from macrosomia-associated traumatism and birth asphyxia: the main finding in the deceased infants was pulmonary hyaline membranes, demonstrated by Louis Gluck in 1973 to result from retarded surfactant maturation in diabetic fetuses.

scholarly journals Candida Chorioamnionitis in Mothers with Gestational Diabetes Mellitus: A Report of Two Cases

2021 ◽  
Vol 18 (14) ◽  
pp. 7450
Author(s):  
Elia Shazniza Shaaya ◽  
Siti Atiqah Abdul Halim ◽  
Ka Wen Leong ◽  
Kevin Boon Ping Ku ◽  
Pei Shan Lim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Umbilical Cord ◽  
Neonatal Death ◽  
Periodic Acid ◽  
Careful Examination ◽  
Periodic Acid Schiff ◽  
History Of ◽  
Methenamine Silver

Background:Candida chorioamnionitis is rarely encountered, even though vulvovaginal candidiasis incidence is about 15%. Interestingly, it has characteristic gross and histological findings on the umbilical cord that are not to be missed. Case Report: We report two cases of Candida chorioamnionitis with presence of multiple yellowish and red spots of the surface of the umbilical cord. Microscopically, these consist of microabscesses with evidence of fungal yeasts and pseudohyphae. The yeasts and pseudohyphae were highlighted by periodic acid– Schiff and Grocott methenamine silver histochemical stains. Both cases were associated with a history of gestational diabetes mellitus. Discussion: Peripheral funisitis is a characteristic feature of Candida chorioamnionitis. It is associated with high risk of adverse perinatal and neonatal outcomes, such as preterm delivery, stillbirth and neonatal death. We recommend careful examination of the umbilical cord of mothers with gestational diabetes mellitus.

scholarly journals Neonatal Morbidity Pattern among Infants Born to Diabetic Mothers at Jamhouria Hospital, Benghazi- Libya

2021 ◽  
pp. 38-55
Author(s):  
Munera Awad Radwan ◽  
Najia Abdelati El Mansori ◽  
Mufeda Ali Elfergani ◽  
Faiaz Ragab Halies ◽  
Mohanad Abdulhadi Lawgali
Keyword(s):  
Diabetes Mellitus ◽  
Birth Weight ◽  
Glycemic Control ◽  
Gestational Diabetes ◽  
Congenital Anomalies ◽  
Maternal Diabetes ◽  
Birth Trauma ◽  
Metabolic Disturbance ◽  
Cardiac Lesion ◽  
Diabetic Mothers

Introduction: Diabetes has long been associated with maternal and perinatal morbidity and mortality. The infant of a diabetic mother have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risks of abortions and stillbirths. Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequallae, including abnormalities of growth, glucose and calcium metabolism, hematologic status, cardio- respiratory function, bilirubin metabolism, and congenital anomalies. The causes of the fetal and neonatal sequallae of maternal diabetes are Multifactorial. However, many of the perinatal complications can be traced to the effect of maternal glycemic control on the fetus & can be prevented by appropriate periconceptional & prenatal care. Objective:  to describe the morbidity pattern among infants of diabetic mothers (IDMs) either gestational or preconception diabetes mellitus. Methods:  A cross sectional study was conducted in Jamhouria hospital/ neonatal ward & enrolled 120 consecutive infants born to diabetics mother either gestational or preconception diabetes mellitus over one year period. Results: 120 babies were diagnosed as IDMs and were admitted to Neonatal intensive care unit, male, female, 74(60.8%) were gestational diabetes, and 46 (38.3%) with preconception diabetes, full term comprise 98 cases (81.6%) while premature were 22 cases (18.3%). For birth weight 20 case [16.7%} were low birth weight, macrosomia represent 16 case (13.3%). Most common congenital anomalies was cardiac lesion 36 cases, for GDM 18 case =24.3% were PCDM 18 case around 40.0%. Central nervous system 11 case (9.1%) all of them dilated ventricular system& only 2 of them need surgical intervention with shunt. Gastrointestinal anomalies 4 cases {3.4%} 2 of them ectopic anus & 2 short bowel syndrome. Most common metabolic disturbance was Hypocalcemia 17 case (14.1%), followed by hypoglycemia 11 case (9.1%), followed with hyper bilirubinemia 3 cases (2.5%) Followed by Respiratory distress syndrome 26 case (21.6%), 17 case hyaline membrane disease (14.1%) ,transient tachypnea of neo born 9 cases (7.5%) , Birth trauma  3 cases Erb,s palsy one of them  birth asphyxia. Conclusion: Most common type of diabetes in pregnancy is gestational diabetes, and most common congenital anomalies is the cardiac lesion & the most common metabolic disturbance is the hypocalcemia. Macrosomia associated with large birth weight as well as birth trauma. Large for gestational age and hypoglycemia associated mainly with poor maternal glycemic control.

scholarly journals Maternal and Perinatal Outcome in Gestational Diabetes Mellitus Compared to Pregestational Diabetes Mellitus

2019 ◽  
Vol 9 (2) ◽  
pp. 127-132
Author(s):  
Faryal Mustary ◽  
TA Chowdhury ◽  
Ferdousi Begum ◽  
Nusrat Mahjabeen
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Pregnant Women ◽  
Perinatal Outcome ◽  
Birth Asphyxia ◽  
Adverse Outcomes ◽  
Intrauterine Death ◽  
Perinatal Complications ◽  
Pregestational Diabetes

Background: Diabetes mellitus is the most frequently encountered endocrine disorder in pregnancy and is associated with adverse outcomes if remain undiagnosed or untreated. This study was done to compare the maternal and perinatal outcome of pregestational diabetes mellitus (PGDM) with that of gestational diabetes (GDM). Methods: This observational analytical study with group comparison was carried out in the Department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka from July 2015 to June 2016. This study was conducted on two groups of pregnant women: group A (PGDM) and group B (GDM). A total of 100 cases were selected and in each group 50 pregnant women were enrolled. Singleton pregnancy and age 18 to 45 years were included. Pregnancy with hypertension, heart disease, renal disease and other metabolic disorders were excluded. Results: In this study mean gestational age of the study subjects were 35.72 ± 2.61 weeks and 36.58 ± 2.34 weeks in PGDM and GDM groups. History of GDM [34.0% vs 16.0%], intrauterine death (IUD) [14.0% vs 2.0%] and abortion [22.0% vas 6.0%] were significantly higher among PGDM patients than GDM patients. Regarding present pregnancy complications, polyhydramnios [32.0% vs 14.0%], preterm delivery [38.0% vs 20.0%], vulvovaginitis [28.0% vs 12.0%] and premature rupture of membrane (PROM) [24.0% vs 8.0%] were significantly higher in PGDM than GDM patients. Wound infection was significantly high in PGDM groups [35.7% vs 11.1%] among the patients delivered by lower uterine Cesarean section (LUCS). Regarding perinatal complications, hypoglycemia [22.0% vs 8.0%], birth asphyxia [24.0% vs 8.0%], RDS [24.0% vs 8.0%] were significantly higher among PGDM comparing GDM patients. Conclusion: The maternal and perinatal outcomes of pregestational diabetes mellitus were less favorable than those of gestational diabetes mellitus. Birdem Med J 2019; 9(2): 127-132

scholarly journals Euglycemic Diabetic Ketoacidosis in a Patient With Gestational Diabetes Mellitus and COVID-19 Infection

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A780-A781
Author(s):  
Gowri Karuppasamy ◽  
Arwa Al Saud ◽  
Wajeeha Mousa Abuhaliqa
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Gestational Age ◽  
Anion Gap ◽  
Calorie Intake ◽  
Fetal Mortality ◽  
Diabetic Patients ◽  
Electrolyte Replacement

Abstract Introduction: Diabetic ketoacidosis (DKA) is a life-threatening medical emergency requiring urgent treatment. Euglycemic DKA may occur in patients with both type 1 and type 2 Diabetes Mellitus (DM), as well as pregnancy. The absence of marked hyperglycemia can result in delayed diagnosis and treatment, resulting in potential adverse outcomes. Diabetes is a major comorbidity associated with severe hospital course and high fatality rate among patients with COVID-19 infection. We report our experience in a patient with gestational diabetes mellitus who developed euglycemic DKA and COVID-19 infection in her third trimester of pregnancy. Clinical Case: A 30-year-old lady at 29weeks gestation presented with two-day history of vomiting, diarrhea and abdominal pain. She reported good fetal movements. She had been diagnosed with Gestational Diabetes Mellitus (GDM) at 20 weeks gestational age, receiving treatment with multiple daily injections of insulin. 5 days earlier, she had tested positive for COVID-19 infection. She was asymptomatic; testing was performed as she had been in contact with a confirmed case. On examination she was afebrile and vitally stable, but dehydrated. Her initial laboratory investigations showed ketonemia with normal glucose level and normal anion gap. She was treated as a case of starvation ketosis and dehydration, with intravenous fluids and electrolyte replacement. However, 3 days later, the patient complained of worsening nausea and vomiting with dry cough and she developed hypotension. Chest X-ray showed bilateral mid and lower zone pulmonary infiltrates. She was treated as COVID-19 pneumonia, received 2 units of COVID-19 convalescent plasma and broad-spectrum intravenous antibiotics. Repeated investigations showed worsening ketosis with high anion gap metabolic acidosis, consistent with a diagnosis of euglycemic DKA. Insulin infusion was initiated, isotonic saline with electrolyte replacement was also continued. She symptomatically improved over the next two days, with resolution of ketonemia and acidosis. The patient was discharged and she was well at her outpatient follow up visit. She underwent emergency Cesarean Section at 37 weeks gestational age, due to non-reassuring electronic fetal monitoring. She delivered a healthy female infant weighing 2445grams. Conclusion: Pregnancy is a high-risk period for DKA particularly when associated with other stressors that were identified in our patient – GDM, restricted calorie intake and COVID-19 infection. Diabetes is a risk factor for developing severe forms of COVID-19 and on the other hand, COVID-19 infection is associated with poor glycemic control and higher risk of hyperglycemic emergencies including ketoacidosis in diabetic patients. Prompt recognition of euglycemic DKA is critical in pregnancy, as this condition is associated with high fetal mortality rates.

scholarly journals Survey of obstetric and neonatal outcome in gestational diabetes mellitus

2021 ◽  
Vol 10 (11) ◽  
pp. 4278
Author(s):  
J. Princy Emil Josephine ◽  
Susan William
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Tertiary Care ◽  
Challenge Test ◽  
Birth Asphyxia ◽  
Fetal Outcome ◽  
Wide Range

Background: India being the diabetic capital of the world, Indian women have a high prevalence of gestational diabetes mellitus (16.5%). It can cause a wide range of complications as well as long term implications in both the mother and fetus. A large proportion of women also progress to become overt diabetics in the future hampering with their quality of life by causing morbidity in various forms. Aim of this study is to evaluate the fetomaternal outcome in women with gestational diabetes mellitus at a tertiary care teaching hospital and the incidence of glucose intolerance in these women during the postpartum period.Methods: All patients attending the antenatal OPD were offered a 75g glucose challenge test and 200 patients diagnosed with GDM were included in the study for a period of one year. Fetomaternal complications were studied and postpartum follow up was done in these patients.Results: Out of these 200 women, 49% delivered via LSCS, 46% via labor naturalis and 5% via instrumental delivery. 59.5% were on insulin and 40.5% were treated with meal plan. Pre-eclampsia complicating pregnancy was seen in 26%, polyhydramnios was encountered in 17.5%, Urinary tract infection in 11%, preterm labour in 8.5% and PROM in 7%. Adverse fetal outcome was seen in 5% of the babies. Birth asphyxia was seen in 7.5%, macrosomia in 13%, 5% of the babies had congenital anomalies. In the postapartum follow up at 6 weeks 22.5% of the study population were glucose intolerant (75 gm OGTT).Conclusions: Early detection and prompt management of this condition can tremendously reduce the short term and long-term complications in both the mother and fetus.

scholarly journals COMPARATIVE STUDY OF TREATMENT OF GESTATIONAL DIABETES MELLI-TUS CITED IN VARIOUS AYURVEDIC AND MODERN RESEARCH PAPERS PUB-LISHED IN LAST 5 YEARS

2020 ◽  
Vol 08 (11) ◽  
pp. 5081-5088
Author(s):  
Swati S. Mohite ◽  
Rahul Gajare ◽  
Namrata B. Khose
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Antioxidant Properties ◽  
Supportive Therapy ◽  
Good Health ◽  
Maternal Diabetes ◽  
First Trimester ◽  
Tinospora Cordifolia ◽  
Third Trimester ◽  
Intrauterine Development

Gestational Diabetes Mellitus is a metabolic disorder during pregnancy. It is defined by WHO as carbohy-drate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during preg-nancy. The entity usually present late in second and third trimester. The factors which constitute good health, i.e. balanced Dosha, Dhatu and Mala, optimally functioning Indriyas or sense organs, a happy con-tented soul and a balanced mind are the very factors that go towards a smooth pregnancy, labour and healthy progeny and this is what Ayurveda treatment focuses on. Pregnancy is a particular time for all women. This condition becomes even more delicate when there is diagnosis of GDM which makes neces-sary controls and therapies that will inevitably affect the women’s life. GDM can lead to potential risk for mother, fetus and child’s development. There is no direct reference of GDM in Ayurveda. But we get ref-erence of Garbhavriddhi excessive increase in size of abdomen and perspiration. Garbhavriddhi or mac-rosomia condition can be interpreted as complication of GDM. In current scenario GDM in pregnancy is one of the major complications during pregnancy. Overt maternal diabetes mellitus can adversely influence intrauterine development. Spontaneous abortions and major congenital anomalies may be induced in the first trimester. Excessive foetal growth, neonatal hypoglycemia, still birth may be induced during second and third trimester. Gestational Diabetes may lead to gangrene, damage of retina, kidneys. If diabetes is not properly controlled, then in the long run fat gets deposited on inner layer of arteries and the possibilities of occurrence of paralysis increase. Complications of diabetes include eye problems and blindness, heart dis-ease, stroke, neurological problems, amputation, and impotence It is needed to cure maternal diabetes as soon as it is diagnosed. Adopting pre-conceptional and thorough antenatal care through Ayurveda; this aims that a woman enters pregnancy in healthy state of body and mind. While describing Garbhadhan vidhi acharyas have advised certain body purifying measures (Sanshodhana karma) followed by special dietet-ics and mode of life for the couple. Ayurveda focuses on change in lifestyle of the Garbhini which helps in maternal health and fetal growth minimizing the complications related to pregnancy. Ayurveda efforts of having healthy baby commences with pre-conception care and management. Pre-conception counselling, Diet, Herbs, Yoga, Asanas are useful as a supportive therapy together with modern medication under su-pervision. The best way to improve your diet is by eating a variety of healthy foods. Various vegetables, pulses, spices, cereals, fruits, dry fruits are helpful in GDM patients. Daily 20 mins walk is also helpful. Ayurvedic herbs like Guduchi, Amalaki, Haritaki, Haridra, Bilva, Neem, Jamun are also useful in GDM. They are having antidiabetic, antioxidant properties. Tinospora Cordifolia are potential therapeutics that act as anti-diabetic drug in the prevention and treatment of GDM. Metformin is safe and effective drug in treatment of GDM. Combination of metformin, diet, Ayurvedic herbs, preconception counselling, Yoga, Pranayama and meditation can give best result in GDM.

scholarly journals A Study of Early Neonatal Deaths at Kathmandu Medical College Teaching Hospital

1970 ◽  
Vol 27 (2) ◽  
pp. 79-82
Author(s):  
M Shrestha ◽  
BL Bajracharya ◽  
DS Manandhar
Keyword(s):  
Birth Weight ◽  
Neonatal Mortality ◽  
Death Rate ◽  
Neonatal Death ◽  
Birth Asphyxia ◽  
Early Neonatal Death ◽  
Extreme Prematurity ◽  
Neonatal Deaths ◽  
Live Births ◽  
Early Neonatal Deaths

Over 9 million deaths occur each year in the perinatal and neonatal periods globally. 98% of these deaths take place in the developing world. Nepal has a high neonatal mortality rate (NMR) of 38.6 per 1000 live births (2001). Two thirds of the newborn deaths usually occur in the first week of life (early neonatal death). Newborn survival has become an important issue to improve the overall health status and for achieving the millennium developmental goals of a developing country like Nepal. Aims and Objectives: This study was carried out to determine the causes of early neonatal deaths (ENND) at KMCTH in the two-year period from November 2003 to October2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the early neonatal deaths in KMCTH during the two-year study period. Details of each early neonatal death were filled in the standard perinatal death audit forms of the Department. Results: Out of the 1517 total births in the two-year period, there were 10 early neonatal deaths (ENND). Early neonatal death rate during the study period was 6.7 per 1000 live births and early neonatal death rate (excluding less than 1 kg) was 6.1 per 1000 live births The important causes of early neonatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and septicaemia. During the study period, there was no survival of babies with a birth weight of less than 1 kg. Among the maternal characteristics, 80% of the mothers of early neonatal deaths were aged between 20-35 years. 50% of the mothers were primigravida. 50% of the mothers of ENNDs had delivered their babies by caesarean section.Discussion: Most of the early neonatal deaths were due to extreme prematurity. Birth asphyxia was the second most important cause of early neonatal deaths. 70% of ENNDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths in KMCTH.Conclusion: Early neonatal mortality at KMCTH is fairly low. Good care during pregnancy, labour and after the birth of the baby has helped to achieve these results. Low cost locally made equipments were used to manage the sick newborns. Reduction of early neonatal deaths require more intensive care including use of ventilators, surfactant and parenteral nutrition and prevention of preterm births Key words: Early neonatal death (ENND), neonatal mortality   doi:10.3126/jnps.v27i2.1584 J. Nepal Paediatr. Soc. Vol 27(2), p.79-82

scholarly journals Risk based screening for gestational diabetes mellitus and its fetomaternal outcome

2019 ◽  
Vol 26 (06) ◽  
Author(s):  
AASMA NAZ QURESHI ◽  
IRFAN AHMED ◽  
ASHOK KUMAR LOHANO ◽  
FARAH AFROZ ◽  
DR.KHAWER HUSSSAIN
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Neonatal Death ◽  
Previous History ◽  
University Hospital ◽  
Operative Delivery ◽  
Cross Sectional ◽  
Still Birth ◽  
History Of

Objectives: The objective of this study is to determine the frequency of factors leading to gestational diabetes mellitus and fetomaternal outcomes. Setting: Department of Obstetrics and Gynaecology Unit-II at Liaquat University Hospital Hyderabad. Study Design:  Cross sectional study. Duration of Study: Six months (1st July 2017 to 31st December 2017). Subject and Methods: A total of 86 Women with GDM included in the study by identification of risk factors from history an examination. A sample of capillary blood was tested with glucometer for random blood sugar level. GDM was diagnosed 2 hours blood glucose more than 126 mg/dl.Women with GDM was evaluated and followed to see the maternal outcome i.e. preterm delivery, pre-eclampsia and operative delivery and fetal outcome i.e. congenital anomalies, live birth, still birth, early neonatal death and macrosomia. All the data was entered on a pre-designed proforma attached at the end of synopsis. Results: The average age of the women was 26.23±4.03 years.  Frequency of factors leading to gestational diabetes mellitus was previous history of previous GDM; 66.3%, Previous history of macrosomia54.7%, Polyhydramnios in current pregnancy 51.2%, macrosomia in current pregnancy 44.2%,  previous history of shoulder dystosia 41.9%, and women with BMI >25kg/m2was observed in 32.6% cases. GDM causes significant maternal and fetal complications including preeclampsia 51.2%, preterm 23.3%, and operative delivery 29.1% as well as fetal death was observed in 21(24.4%) in which 17.44% still birth (15/86) and 6.98 (6/86) were neonatal death. Conclusion: Gestational Diabetes Mellitus is associated with increased morbidity in mothers and fetus. Early detection and intervention is important because it improves pregnancy outcome.

scholarly journals Pregnancy Outcome in Gestational Diabetes Mellitus

2015 ◽  
Vol 3 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Anu Bajracharya ◽  
Rachana Saha ◽  
Archana Shakya
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Gestational Hypertension ◽  
Perinatal Outcomes ◽  
College Teaching ◽  
Maternal Diabetes ◽  
Neonatal Complications ◽  
Medical College ◽  
Good Glycaemic Control

Background: Gestational diabetes mellitus is a metabolic disorder defined as glucose intolerance with the onset or fi rst recognition during pregnancy. Gestational diabetes mellitus is associated with higher incidence of maternal diabetes mellitus later in life. It poses a risk to the pregnant woman and to the fetus. Hence, it is imperative for an early detection and management of the disease to ensure better maternal and foetal outcomes. Objective: To assess the prevalence of gestational diabetes mellitus and to analyze the maternal and perinatal outcomes of gestational diabetes mellitus patients who delivered in the hospital during the study period. Methods: A hospital based descriptive observational study was conducted at Kathmandu Medical College Teaching Hospital for a period of one year from 1st January 2013 to 31st December 2013. All the cases of gestational diabetes mellitus were included in the study. Patients were followed from the time of admission to the time of discharge after delivery. Pertinent information obtained were demography, gestational age at diagnosis and delivery, pregnancy complications, intervention and perinatal morbidity and mortality. Results: Out of 2845 deliveries, 45 patients were diagnosed as gestational diabetes mellitus and admitted during the period of study. The prevalence of gestational diabetes mellitus was 1.58% in this hospital. The most common maternal and neonatal complications were gestational hypertension (20%), hypoglycemia (8.89%) and macrosomia (8.89%) respectively. Conclusion: This study is important in providing information about the maternal and neonatal outcomes of gestational diabetes. By proper monitoring and good glycaemic control during the antenatal period, the adverse maternal and neonatal complications of gestational diabetes mellitus can also be reduced.DOI: http://dx.doi.org/10.3126/jkmc.v3i3.12246Journal of Kathmandu Medical CollegeVol. 3, No. 3, Issue 9, Jul.-Sep., 2014, Page: 107-112

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