Diabetes in pregnancy: health risks and management

Diabetes in pregnancy is increasing and therefore it is important to raise awareness of the associated health risks to the mother, the growing fetus, and the future child. Perinatal mortality and morbidity is increased in diabetic pregnancies through increased stillbirths and congenital malformation rates. These are mainly the result of early fetal exposure to maternal hyperglycaemia. In the mother, pregnancy may lead to worsening or development of diabetic complications such as retinopathy, nephropathy, and hypoglycaemia. This review defines pregestational and gestational diabetes and the associated health risks to the growing fetus and mother. Management is discussed, focusing on clinical evidence based guidelines published by the American Diabetic Association and the UK National Institute for Health and Clinical Excellence on the management of pregnant women with pre-existing diabetes.     

Asthma management during pregnancy

Asthma is estimated to affect up to 7% of pregnancies. Patients should be aggressively managed as poor asthma control during pregnancy can lead to poor outcomes for mother and child. Though there are no randomized double-blind placebo-controlled studies of asthma medications during pregnancy, data suggests that undertreatment of asthma poses more risk to mother and fetus than does appropriate use of asthma medication. Asthma therapy includes patient education, environmental control measures, appropriate pharmacotherapy and specific allergen immunotherapy.     

Delayed diagnosis of cervical pregnancy: management options

Cervical pregnancy is an uncommon variety of ectopic gestation. The aetiology is obscure. Diagnosis can be missed unless early evaluation is done by experienced personnel utilising pelvic ultrasonography. Three cases of cervical pregnancy managed at this hospital are described illustrating difficulties in early diagnosis and possible association with previous uterine scar and prior curettage of the uterus for retained products of conception. Treatment options vary according to the clinical state of the patient at the time of diagnosis. Non-surgical methods including systemic methotrexate administration in one and surgical evacuation of products of conception with subsequent cervical cerclage in another are discussed. Surgical interventions like total abdominal hysterectomy with internal iliac artery ligation to arrest life-threatening pelvic haemorrhage is also described. Other treatment options include potassium chloride (KCl) alone or in combination with methotrexate.     

前置胎盘孕妇孕期管理方法对妊娠结局的影响

目的探讨前置胎盘孕妇孕期管理方法,降低围产期母儿发病率。方法收集龙泉驿区2007年10月～2011年9月产前诊断前置胎盘孕妇183例,对孕期管理进行回顾性分析,其中2007年10月～2009年9月前置胎盘孕妇单纯由产科检查单位管理,为对照组：2009年10月～2011年9月前置胎盘孕妇采用三级管理方式,加强社区护士在管理工作中的作用,为观察组。比较两组的母亲妊娠结局及围产儿结局。结果观察组孕妇产前出血发生率、早产率、围产儿发病率低于对照组,差异有统计学意义。结论加强社区护士在前置胎盘孕妇孕期管理中的作用,可有效降低围产期母儿发病率。     

孕期体重管理对妊娠结局的影响研究

目的探讨孕期体重管理对妊娠结局的影响。方法收集2015年1月～2017年10月期间在我院进行孕期体检的初孕产妇350例,按照是否给予孕期体重管理分为两组,每组175例。对照组常规孕检,未实施体重管理;研究组在对照组的基础上实施体重管理,比较两组不同孕周BMI值;妊娠期高血压、妊娠期糖尿病、巨大儿、产后出血、胎儿宫内窘迫情况及分娩方式。结果研究组孕24周、32周、38周BMI值均低于对照组(P0.05)。研究组妊娠期高血压、妊娠期糖尿病、巨大儿、产后出血、胎儿宫内窘迫发生率均低于对照组,自然分娩率高于对照组(P0.05)。结论体重管理能够将孕妇BMI增长控制在正常范围内,有效降低妊娠期高血压、巨大儿等发生率,孕妇的分娩结局更好。