Diabetes and pregnancy: analysis of pregnant women submitted to fetal echocardiography during a ten-year period

Objectives: To analyze diabetic pregnant women who underwent fetalechocardiography , from April 1993 to December 2003, and to identify the fetal echocardiographic abnormalities and postnatal outcome. Methods: A retrospective cross-sectional study of 178 diabetic pregnant women who underwent fetal echocardiography. Clinical and laboratory maternal, fetal echocardiographic, delivery and newborn variables were studied. Means were calculated for quantitative variables and percentages for qualitative variables. Analysis of variance, Student’s t test and the Dunnet’s test were used. The adopted level of significance was p < 0.05. Results: There were 20,493 deliveries in the period considered, of which 380 were of diabetic mothers and 178 of them were studied. Mean age was 33.7 years (± 5.0). The mean body mass index (BMI) at the first prenatal appointment was 28.0 kg/m2. The majority (84.8%) underwent fetal echocardiography at ≥ 28 weeks of gestation. Nine cases of interventricular septum hypertrophy were found (5.1%), threecases (1.7%) of cardiac malformation were identified, one of which was a false-positive and, among the normal cases, one false-negative was identified. Six stillbirths occurred, three from women with gestational diabetes (2.4%) and three from type 2 diabetics (6.3%, p = 0.305). The rates of major congenital malformations among gestational and type 2 diabetes were 5.6 and 10.4%, respectively (p = 0,322). Conclusions: The sample studied showed older women, of higher than normal BMI. Only few type-1 diabetes patients were observed. The frequency of malformation and perinatal mortality rate were similar to those reported in the literature. Perinatal outcomes in this population were also similar to those referred in the literature

Video laparoscopic intervention for an interstitial pregnancy after failure of clinical treatment

CONTEXT: Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations. CASE REPORT: In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the β subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case

Intervenção videolaparoscópica na gestação intersticial após falha com o tratamento clínico

CONTEXT: Interstitial pregnancy is a rare form of ectopic pregnancy for which the best therapeutic course of action has yet to be determined. Surgical intervention entails a high risk of hemorrhage due to the great vascularization of the cornual region of the uterus. Case descriptions facilitate the analysis of results and aid clinicians in determining the most appropriate course of action in these situations. CASE REPORT: In a patient with an ultrasound diagnosis of interstitial pregnancy, clinical treatment using methotrexate was chosen. However, after one week, there was a marked decline in the serum level of the &#946; subunit of chorionic gonadotropin hormone, although an ultrasound examination revealed embryonic cardiac activity. A second dose of the chemotherapy was administered. Embryonic cardiac activity persisted 48 hours later. Video laparoscopy was performed to achieve right-side cornual resection, which resulted in satisfactory resolution of the case