Damage Control Resuscitation and Surgery is the concept of controlled hypotension, haemostatic resuscitation and abbreviated surgical procedures following severe trauma; the practice of which has resulted in improved mortality and morbidity. We describe a rare case of thoraco-abdominal impalement successfully managed based on the concept of Damage Control Resuscitation.
Hypotension

To observe the maternal and neonatal outcomes among women with diabetes mellitus in pregnancy as compared to healthy control. A case-control study involving 400 women with DM who delivered between 2005 to 2009 was done with age-matched control group. A total of 305 women (76.25%) were gestational diabetes mellitus (GDM) on diet control, 79 (19.75%) were GDM on insulin and 16 (4%) were pre-existing DM. The mean body mass index of the women with diabetes was higher compared to the age-matched healthy women (p <0.001). Approximately one-third of diabetic woman had no antecedent risk factor. About half of the women with diabetes (n=205, 51.3%) had unplanned pregnancy. Women with DM had greater risk of having spontaneous miscarriage and caesarean section (OR 1.4, 95% CI (1.2-1.7), OR 1.3, 95% CI (1.1- 1.5) respectively). Women with diabetes on insulin had higher risk of preterm delivery and caesarean delivery as compared to those with diet control, (OR 1.7, 95% CI (1.2- 2.5), OR 2.5, 95% CI (1.6-4.1) respectively). The incidence of macrosomia, low Apgar score, need for NICU admission, hypoglycaemia and respiratory distress syndrome (RDS) were higher among women with diabetes as compared to healthy control, and especially in those on insulin. Women with higher HbA1c had significantly increased need for caesarean section and NICU admission with higher incidence of macrosomia and RDS. The overall outcome of women with diabetes especially with higher level HbA1c remained poor as compared to a normal pregnancy.