Gestational diabetes mellitus in women with multiple pregnancies: is the metabolic abnormality milder?

Objective: We aimed to compare maternal characteristics and dysglycemia after delivery in women with gestational diabetes mellitus (GDM) according to pregnancy being multiple (MP) or singleton (SP). The hypothesis was that women with GDM and MP would have a milder glycemic abnormality before and after pregnancy than those with SP.

Methods: We performed a cohort study of 2908 women giving birth between 1986 and 2009. Logistic regression was performed to discriminate between MP and SP after anamnestic pre-pregnancy characteristics. Kaplan–Meier and Cox regression analyses were performed to assess if MP was independently associated with both impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) and diabetes after delivery.

Results: Family history of diabetes was the only independent anamnestic pre-pregnancy characteristic discriminating MP versus SP, OR 2.04 (95% CI 1.12, 3.70, p 0.019). The median time to progress to IFG/IGT was 7.52 years in SP (95% CI 6.92, 8.13) and 7.41 in MP (95% CI 3.84, 10.98), ns and the progression to DM did not differ. In addition, MP was not associated to IFG/IGT or to DM in the Cox regression analysis.

Conclusions: In this cohort of women with GDM, those with MP did not demonstrate a lesser degree of dysglycemia after controlling for other pregnancy characteristics and pregnancy-independent factors.     

Gestational weight gain and pregnancy outcomes in obese women: how much is enough?

OBJECTIVE: To examine the effect of gestational weight change on pregnancy outcomes in obese women. METHODS: A population-based cohort study of 120,251 pregnant, obese women delivering full-term, liveborn, singleton infants was examined to assess the risk of four pregnancy outcomes (preeclampsia, cesarean delivery, small for gestational age births, and large for gestational age births) by obesity class and total gestational weight gain. RESULTS: Gestational weight gain incidence for overweight or obese pregnant women, less than the currently recommended 15 lb, was associated with a significantly lower risk of preeclampsia, cesarean delivery, and large for gestational age birth and higher risk of small for gestational age birth. These results were similar for each National Institutes of Health obesity class (30-34.9, 35-35.9, and 40.0 kg/m(2)), but at different amounts of gestational weight gain. CONCLUSION: Limited or no weight gain in obese pregnant women has favorable pregnancy outcomes.     

Histology and prevalence of ovarian tumours in postmenopausal women: is follow-up required in all cases?

The objective of this study was to determine if follow-up is required for all ovarian tumours incidentally diagnosed in postmenopausal women, by studying the prevalence and histology of ovarian tumours in postmenopausal women undergoing hysterectomy. The histopathology of adnexa in 100 consecutive postmenopausal women who underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy for various indications, was reviewed. A total of 200 adnexa were examined. Ovarian pathology was found in 62/200 (31%). Of these 34/62 (53%) were unilocular cystic tumours, 9/62 (15%) were multilocular tumours, 11/62 (18%) were solid tumours and 8/62 (11%) were uni or multilocular with solid elements. The prevalence of borderline tumours was 4% and that of malignant tumours was 5%. All tumours < 2 cm were found to be benign. All unilocular cysts < 5 cm were benign. In conclusion, a vast majority of ovarian tumours in this group of women were benign. It may be reasonable not to follow-up women with unilocular ovarian tumours < 5 cm who have a normal CA125.     

Gestational diabetes mellitus in women in the fourth decade--is treatment worthwhile?

AIM: To examine the influence of diet-treated gestational diabetes mellitus on the obstetric performance of mothers aged 40 and above. METHOD: We reviewed the delivery records of 205 mothers aged 40 and above who delivered over a 3-year period. A 75-gram oral glucose tolerance test was performed in all cases and 64 (31.2%) (18 primiparas and 46 multiparas) had gestational diabetes mellitus. This affected group of patients was compared with a group of age- and parity-matched controls to determine the impact of gestational diabetes mellitus on the obstetric outcome. RESULTS: There was no difference in the maternal anthropometric parameters, antenatal complications, or labor performance. While no statistically significant difference was found in the infant anthropometric parameters, the study group had a lower incidence (p = 0.043) of large-for-gestational age infants. CONCLUSION: Our findings suggested the adverse effects of gestational diabetes mellitus on pregnancy outcome were confounded to a large extent by other factors such as age, parity, and obesity. Once compared with matched controls, gestational diabetes mellitus that can be successfully treated with diet therapy probably had minimal adverse effect on the obstetric outcome. Furthermore, diet treatment can probably reverse the effect of advanced maternal age on infant size in these women.     

Ovarian stimulation: is exogenous LH necessary in all patients?

FSH and LH play an essential but different role in the growth of ovarian follicles during the cycle. In stimulation protocols, good follicular development is obtained in most patients treated with FSH alone whereas the role of LH is more complex and controversial. Clinical and pre-clinical studies have shown that optimal follicular development is obtain if (i) exposure to endogenous and/or exogenous LH is sufficient ("threshold" concept) and (ii) exposure to LH is not excessive ("ceiling" concept). The recombinant luteinizing hormone (r-hLH, Luveris) is the only available stand-alone preparation of LH. Its characteristics are a high specific activity, the absence of undesirable proteins and an excellent batch to batch consistency. Luveris is indicated in association with FSH for stimulating follicular development in LH and FSH deficient women (defined by an endogenous LH level < 1.2 UI/l). In this subgroup of patients, the therapeutic benefit of exogenous LH at a daily dose of 75 IU is only observed when endogenous serum LH is below than 1.2 IU/l: LH threshold concept. In ART, the combination of exogenous LH at a daily dose from 75 to 150 IU and recombinant FSH improved the ovarian stimulation results only in a minority of patients (5 to 17%). On the opposite, studies conducted in OMS I and II patients showed that high doses of exogenous LH lead to atresia of secondary follicles. So, a daily dose of exogenous LH greater than 225 IU had a deleterious effect on follicular growth: LH ceiling concept.     

Breast binding... is it all that it's wrapped up to be?

OBJECTIVE: To investigate the difference in breast symptoms between breast binding and support bra wearing in nonbreastfeeding postpartum mothers. DESIGN: A systematic replication of an earlier study by Bristol using a pre-experimental posttest design. SETTING: A private, for-profit hospital in a city in the south-central region of the United States. PARTICIPANTS: Sixty nonbreastfeeding postpartum women who gave birth to viable newborns of singleton gestations, had an uncomplicated postpartum, and did not receive hormonal lactation suppressants. MAIN OUTCOME MEASURES: Postpartum breast engorgement, leakage, tenderness, and use of pain relief measures as measured by the Bristol Record of Symptoms. RESULTS: Analysis of the data revealed no significant difference relative to breast engorgement between the two groups during the first 10 postpartum days. However, the breast-binder group reported a greater degree of breast tenderness, breast leakage, and use of other pain relief measures. CONCLUSION: Breast binding should be discontinued as a method of lactation suppression and use of support bras encouraged. Future studies need to focus on comfort for nonbreastfeeding, postpartum mothers.     

Efficacy of Essure hysteroscopic sterilization – 5 years follow up of 1200 women

Abstract

Objective: To assess the efficacy of the Essure hysteroscopic birth control device after 5 years follow up.

Study design: Retrospective analysis of case series.

Setting: Outpatient hysteroscopy facility in a large teaching hospital.

Subjects: One-thousand three-hundred and twenty-one women who underwent hysteroscopic sterilization with Essure device (Conceptus, Inc., Mountain View, CA) between January 2003 and May 2005

Intervention(s): Hysteroscopic tubal sterilization using Essure system.

Main outcome measure: Efficacy/effectiveness, failure rate.

Results: Satisfactory insertion was accomplished in the first attempt in 1166 women (97.16%). After the second attempt, successful insertion rate rise to 98.6%. (n?=?31, 2.6%). Three pregnancies had been reported after 5 years follow up, which implies an overall absolute rate of 0.25%. This represents a Pearl index of 0.05 after 72?000 months of surveillance. All of them occurred in the first year of use of the microinsert. There has been no unintended pregnancy in the next 4 years.

Conclusion(s): Essure has the lowest Pearl index never published being the most effective permanent birth control system to date. Unintended pregnancies tend to occur in the first year after the insertion, and can be avoided encouraging women to accomplish the protocol.     

Pre-eclampsia: Is it a different disease in primiparous and multiparous women?

The aim of this study was to evaluate differences in clinical and laboratory parameters and differences in the complication rates between pre-eclamptic primiparous and pre-eclamptic multiparous women. A prospective case series of 112 primiparous and 186 multiparous women with pre-eclampsia was conducted at Princess Badea Teaching Hospital; a large tertiary public health service hospital in Irbid, North Jordan. A uniform medical and surgical management protocol was implemented. The main outcome measures included antenatal, intrapartum and puerperal, maternal and foetal complications. Multiple maternal and foetal demographic, clinical and laboratory parameters were studied. As expected, the primiparous were younger than the multiparous women. After adjusting for maternal age, regression analysis revealed no difference in the systolic or diastolic blood pressure in the two groups. It was also demonstrated that there was no statistically significant difference in the clinical presentation, haematological and biochemical parameters or ultimate maternal outcome between the two groups. After adjusting for babies’ sex and gestational age, it was demonstrated that there was no statistically significant difference in the following: gestational age at delivery, foetal weight, stillbirth, admission rate to neonatal intensive care unit, neonatal death rate within the first four weeks after birth and incidence of intrauterine growth restriction between the two groups     

Should a diagnosis of endometriosis be sought in all symptomatic women?

A tool is needed to enable clinicians to determine whether women wish to seek a pathology-based explanation for chronic pelvic pain or whether they just want symptom relief. Such an approach might reduce the number of unnecessary laparoscopies without adversely affecting outcomes.     

Awaiting blood pressure stabilization in ambulatory pregnant women: is 5 minutes sufficient?

Objective: Current recommendations for timing of blood pressure measurement in ambulatory pregnant women vary and are based on studies in the nonpregnant population. The objective of this study was to determine if there is a difference in systolic blood pressure (SBP) and diastolic blood pressure (DBP) between minute-5 and minute-10.

Methods: A prospective study was conducted at our prenatal care clinics. Participants had their blood pressure measured upon sitting and every 5?minutes for 15?minutes. Initial SBP and DBP were compared to measurements at each time point. Additionally, the SBP and DBP at minute-5 were compared to minute-10. All statistical tests were two-sided.

Results: Data from 400 patients were analyzed. Of these, 34.0% were in the first, 30.7% were in the second trimester, and 35.2% were in the third trimester. In each trimester, there was a significant difference in the SBP and DBP at minute-5 compared to minute-0. At minute-10 compared to minute-5, there was no further drop for all trimesters, except for a small drop in DBP in the second trimester (?1.3?±?6.0, p?=?0.012).

Conclusion: In an ambulatory setting, 5?minutes after sitting appears to be an appropriate time point to measure blood pressure in pregnancy.