*Abortion, Criminal ; *Abortion, Habitual ; *Abortion, Missed ; *Abortion, Septic ; *Abortion, Threatened ; *Malaysia ; *Maternal Mortality ; *Statistics ; *Adolescent ; *Pregnancy

Gestational diabetes mellitus (GDM) is traditionally defined as newly onset or detected carbohydrate intolerance during pregnancy. Unprotected exposure to high glucose levels during pregnancy is related to adverse pregnancy outcomes including fetal demise and intrauterine growth restriction associated with placental insufficiency. The most common complications related to GDM comprise macrosomia, shoulder dystocia, brachial plexus palsy, intrauterine fetal death and preeclampsia, polyhydramnios, preterm delivery, and increased cesarean section rate. Moreover, GDM may increase the chance of GDM recurrence in a subsequent pregnancy, impaired glucose tolerance or type 2 DM, and obesity or impaired glucose tolerance in the offspring. Therefore, proper obstetrical management and glucose control are always challenging and important. The aim of this article is to discern: 1) obstetric complications related to GDM diagnosed after pregnancy, 2) various methods of fetal surveillance, 3) proper timing for delivery and mode of delivery, 4) postpartum management for GDM patients and neonates, and 5) preconceptional counseling prior to a possible subsequent pregnancy.
Brachial Plexus ; Cesarean Section ; Counseling ; Diabetes, Gestational* ; Dystocia ; Female ; Fetal Death ; Glucose ; Humans ; Infant, Newborn ; Obesity ; Obstetrics ; Paralysis ; Placental Insufficiency ; Polyhydramnios ; Postpartum Period ; Pre-Eclampsia ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome ; Recurrence ; Shoulder

*Abnormalities, Drug-Induced ; *Abruptio Placentae ; *Anesthesia, Obstetrical ; *Blood Coagulation Disorders ; *Delivery, Obstetric ; *Embolism, Amniotic Fluid ; *Fetal Death ; *Maternal-Fetal Exchange ; *Obstetrics ; *Postpartum Period ; *Pre-Eclampsia ; *Prenatal Care ; *Thrombophlebitis ; *Urinary Tract Infections ; *Infant, Newborn ; *Pregnancy

Estriol excreation was studied in 216 normal and 61 pathologic pregnancies. The 95% fiducial limits of the normal excretion of estriol, within which 95% out of 100 future determinations in normal pregnancies are expected to fall, were established. The estriol curve in normal pregnancy in this study agrees well in its general shape with those presented by previous investigators who used different chemical methods of determination. The estriol values in pathologic pregnancies with preeclampsia. intrauterine fetal death and antepartum hemorrage have been analyzed. The clinical significance of estriol determinations during pregnancy was discussed.
Estriol/urine* ; Female ; Fetal Death/urine ; Human ; Pre-Eclampsia/urine ; Pregnancy* ; Pregnancy Complications/urine* ; Uterine Hemorrhage/urine

OBJECTIVE: To evaluate the clinical profiles and outcomes of patients with placental abruption and the effect of hypertensive disorders on perinatal death. METHODS: It was a retrospective study over 9 years from 1 January 1995 to 31 December 2003. We reviewed the data of women (N=104) presenting placental abruption among 10,940 women who were delivered at this hospital. RESULTS: The incidence of placental abruption was 0.95% or one in 104 deliveries. Only 47.6% of these could be diagnosed before delivery. The most common symptom was vaginal bleeding (71.1%) and intrauterine fetal death had already occurred in 26.9%. Perinatal mortality rate was 32.6% including still birth (26.9%) and neonatal death (5.7%). There was no maternal death. 28.8% of placental abruption were associated with preeclampsia and other hypertensive disorders but in most cases (68.3%), the contributing factors could not be found. When the hypertensive disorders were associated, perinatal mortality rate was 33%, which was not significantly different when compared with perinatal mortality (32%) without hypertensive disorder (p>0.05). But the neonates from the hypertensive women were more growthly impaired than those from normotensive women (p<0.05). CONCLUSION: Hypertensive disorders was an important factor in women with placental abruption but in most cases the contributing factors could not be found. The hypertensive disorders did not aggravate the perinatal mortality but increased the rate of intrauterine growth retardation in placental abruption.
Abruptio Placentae* ; Female ; Fetal Death ; Fetal Growth Retardation ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Parturition ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy* ; Retrospective Studies ; Uterine Hemorrhage

OBJECTIVE: To evaluate obstetric variables in the placental abruption that affect on perinatal mortality. METHODS: We reviewed clinical data of all singleton deliveries complicated with placental abruption between January 2000 and December 2007, in Department of Ob. & Gyn., Sanggye Paik Hospital. RESULTS: Placental abruption complicated 54 cases (0.55%) of all deliveries (n=9,903) from January 2000 to December 2007. The peak age was 26-30 years (42.1%). The most common symptom was vaginal bleeding (57.4%) and intrauterine fetal death had already occurred in 9.3%. Perinatal mortality rate was 13.0% and there was no maternal death. 38.9% of placental abruption occurred between 33 to 36weeks of gestational age. 38.9% of placental abruption was diagnosed before delivery with ultrasonography and 9.3% was chronic placental abruption. 33.3% of placental abruption was associated with preeclampsia, and then associated with PPROM (24.1%), uterine myoma (3.7%), chronic hypertension (1.9%) and smoking (1.9%). When the hypertensive disorders were associated, fetal distress rate was higher than normotensive pregnancy (63.2% vs 20.0%, P-value: 0.005). Mean gestational age (days) (194+/-32.8 vs 248.12+/-28.0, P-value<0.001) and the severity of placental abruption (P-value: 0.005) affect perinatal mortality in placental abruption. The most common complication of placental abruption was DIC (16 cases, 29.6%), followed by Couvelaire uterus (4 cases, 7.4%) and uterine rupture (1 case, 1.9%). CONCLUSION: Obstetric variables that affect perinatal mortality were gestational age at the diagnosis and the severity of placental abruption.
Abruptio Placentae ; Dacarbazine ; Female ; Fetal Death ; Fetal Distress ; Gestational Age ; Hypertension ; Maternal Death ; Myoma ; Perinatal Mortality ; Pre-Eclampsia ; Pregnancy ; Smoke ; Smoking ; Uterine Hemorrhage ; Uterine Rupture ; Uterus

To determine the perinatal mortality and morbidity of fetuses with absent end-diastolic velocities (AEDV) of the umbilical artery in severe pre-eclampsia and eclampsia, the outcome of 5 fetuses with AEDV was compared with that of 35 fetuses with positive end-diastolic velocities (PEDV). The study population comprised 38 cases of severe pre-eclampsia and 2 cases of eclampsia with structurally normal singletons, who had had umbilical artery Doppler velocimetry weekly from admission to delivery. The Doppler velocimetry result was not used for the clinical management. Perinatal death and neonatal morbidity from both groups were further examined in gestational age category to control the influence of preterm births. The incidence of AEDV of the umbilical artery Doppler velocimetry in severe pre-eclampsia and eclampsia was 12.5% (5/40). The AEDV group had a significantly higher incidence than the PEDV group in terms of ceasarean section due to fetal distress (60% : 17%), Apgar score < 7 at 5 minutes (60% : 14%), perinatal death (25% : 0%) and assisted mechanical ventilation (67% : 9%) both at 32-36 weeks. Time intervals from the detection of AEDV to delivery of live neonates varied from the day to 15 days. In conclusion, AEDV in the umbilical artery might be of clinical value in routine surveillance of pregnancies complicated by severe pre-eclampsia and eclampsia, and predict hypoxic fetal condition which needs operative interventions before or during labor and mechanical ventilation after birth.
Apgar Score ; Cesarean Section ; Dystocia ; Eclampsia* ; Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Mortality ; Parturition ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Premature Birth ; Respiration, Artificial ; Rheology ; Trial of Labor ; Umbilical Arteries* ; Uterine Rupture

OBJECTIVE: The purpose of this study was to evaluate the outcome and safety of vaginal delivery after previous cesarean birth. METHODS: This study was based on 303 cases of delivery with previous cesarean birth at Masan, Fatima Hospital from May, 1997 to April, 1998. Among them, 62 cases had performed trial of labor. We had made a comparison between elective repeat section group and trial of labor group by analizing the frequency, successful rate, maternal morbidity, perinatal morbidity and mortality. RESULTS: Among 303 cases with previous cesarean birth, trial of labor was done in 62 cases(20.5%). Among trial of labor group, vaginal delivery was done in 54 cases (87.1%) and repeat section was done in 8 cases(12.9%). Indications for elective repea section before the onset of labor were refuse trial of labor(51.9%), request for tubal ligation(17.4%), and previous section > or =2(7.5%), etc. The successful rate of vaginal delivery according to indication for previous cesarean birth was 85.0%(17/20) in the cases of dystocia and 88.1%(37/42) in the cases except dystocia. The successful rate was not influenced by the indication for previous cesarean birth(P>0.05). There were no maternal death or uterine rupture in the cases of trial of labor. There were no significant difference between elective repeat section group and trial of labor group in maternal morbidity, perinatal morbidity and mortality(P>0.05). CONCLUSION: Under strict indications, vaginal delivery subsequent to cesarean birth may be safe, and can reduce the rate of cesarean section that was increased constantly.
Apgar Score ; Cesarean Section ; Dystocia ; Eclampsia* ; Female ; Fetal Distress ; Fetus ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Maternal Death ; Mortality ; Parturition ; Parturition* ; Perinatal Mortality ; Pre-Eclampsia* ; Pregnancy ; Premature Birth ; Respiration, Artificial ; Rheology ; Trial of Labor ; Umbilical Arteries* ; Uterine Rupture

The purpose of this study is to estimate early neonatal mortality rate in relation to obstetric factors. The early neonatal mortality rate was estimated on live births with a gestational period more than 28 weeks who died during the first 7 days of life in Ewha Womans University Hospital fro-m Jan. 1974 to Dec. 1978. During this period, there were 8218 single births and 127 early neonatal deaths. 1. We had 127 deaths out of 8218 single births, and early neonatal mortality rate came to 15.5 per 1000 live births. 2. The early neonatal mortality rate was increased in cases of maternal age over 40, higher in multipara, who had delivered more than 4 times, who had frequent abortions (more than 5 times) and it was also higher in para-one than para-two. 3. The early neonatal mortality rate was 7.9 times higher in abnormal presentation of fetus than normal one. 4. There was no significant difference in early neonatal mortality rate between spontaneous vaginal delivery and Caesarian section delivery, but significant high mortality rate was noted in breech delivery. 5. In cases of anemic mother (Hemoglobin less than 10 gm%, Hematocrit less than 32%), the early neonatal mortality rate was 2.8 times higher than non-anemic group. 6. The early neonatal mortality rate of babies from mothers without antenatal care was 3 ti-mes higher than that of mothers who had. 7. Hypertensive disorders in pregnancy was present in 15.8% of all live births and early neo-natal mortality rate was 10.8. The mortality rate was 6.5 times higher in chronic hypertensive vascular disorder with toxe-mia than in preeclampsia and 3.7 times higher in eclampsia than in precclampsis. 8. The obstetric complication which increased early neonatal mortality rate were polyhydra-mnios, amnionitis, abruptio placentae etc.
Abruptio Placentae ; Amnion ; Chorioamnionitis ; Eclampsia ; Female ; Fetus ; Hematocrit ; Humans ; Infant ; Infant Mortality* ; Live Birth ; Maternal Age ; Mortality ; Mothers ; Parturition ; Pre-Eclampsia ; Pregnancy

OBJECTIVE: The study was carried out to assess whether a sudden rise in the serum CA 125 level might predict spontaneous abortion in the first trimester. In the process, we assessed the clinical value of maternal CA 125 in patients with missed abortion and evaluate the prognostic significance of CA 125 in early normal pregnancies, threatened abortions. The purpose of this study was to prospectively compare serum CA 125 levels among women who abort in the first trimester, who experience threateneda bortion and who go through normal pregnancy. METHODS: Between March 2001 and September 2001, a total of 133 patients were observed in the Department of Obstetrics and Gynecology at CHA Hospital. Fifty-eight with missed abortions, forty-five with threatened abortions and thirty normal pregnancies (no history of endometriosis or ovarian mass) were evaluated during gestational age 6 to 12 weeks and maternal serum samples were collected. All patients were sonographically assessed and CA 125 values were compared. RESULTS: There was no statistically significant difference in the CA 125 levels between the spontaneous aborted patients and the patients without abortion: missed abortion, 72.9 +/- 102.0IU/ml (range 7.3-487.6); threatened abortion, 46.6 +/- 37.9IU/ml (range 13.9-206.1); normal pregnancy, 63.4 +/- 61.2IU/ml (range 13.8-62.8). CONCLUSION: Our study shows that serum CA 125 levels are not predictive of spontaneous abortion in the first trimester and failed to discriminate among missed abortions, threatened abortions, and normal pregnancies.
Abortion, Missed ; Abortion, Spontaneous ; Abortion, Threatened ; Endometriosis ; Female ; Gestational Age ; Gynecology ; Humans ; Obstetrics ; Pregnancy Trimester, First* ; Pregnancy* ; Prospective Studies