misoprostol and Diabetes--Gestational

This article describes the use of a balloon catheter introduced via the femoral artery into the abdominal aorta without the use of fluoroscopy to stabilize six patients with life-threatening post-partum haemorrhage. The femoral artery was localized blindly or with the use of ultrasound. Immediate control of the bleeding was achieved in all patients, and the procedure was believed to be life saving for some patients. One patient with a narrow and fragile aorta had an aortic rupture necessitating surgical repair, which may have been caused by the balloon. In these six cases, the procedures were carried out by interventional radiologists. However, this procedure can also be performed by anaesthesiologists or surgeons who are trained in vascular access techniques.

Topics: Adult; Blood Pressure; Blood Substitutes; Cardiotonic Agents; Catheterization; Diabetes, Gestational; Embolization, Therapeutic; Erythrocyte Transfusion; Female; Glucose Intolerance; Humans; Hysterectomy; Infant, Newborn; Intra-Aortic Balloon Pumping; Misoprostol; Oxytocics; Oxytocin; Patient Care Team; Postpartum Hemorrhage; Pregnancy; Ultrasonography

To report our intrapartum experience with routine delivery at 38 weeks of gestation of A-2 diabetic pregnancies requiring primarily oral hypoglycemic therapy.. This retrospective study consisted of 143 consecutive women with gestational diabetes not controlled with diet alone (A-2). Each underwent a routine trial of labor at 38 weeks of gestation. The preinduction condition of the cervix, need for oxytocin, and primary cesarean rates were primary endpoints. For comparison, a control group during that same period consisted of 137 consecutive diet-controlled diabetic (A-1) pregnancies with the same eligibility criteria who underwent expectant management at 38 weeks.. The study group was more likely to have an unfavorable cervix (75% versus 45%; p < 0.001) and to require oxytocin (76% versus 56%; p < 0.001). Early onset meconium was less common in the study group (3.5% versus 13.1%; p < 0.01). Primary cesarean rates were low and not different between the study and control groups (12.7% versus 11.7%; p < 0.8). The only stillbirth was in the control group and was associated with a tight double nuchal cord encirclement. Mean birth weights and the frequency of birth weights > 4000 g were not different between groups. Shoulder dystocia, low Apgar scores, and admissions to the special care nursery were infrequent in either group. No respiratory difficulties requiring resuscitation or prolonged nursery care were encountered.. Routine delivery at 38 weeks in an A-2 diabetic population is not associated with additional intrapartum morbidity or a greater need for cesarean delivery.

Topics: Administration, Oral; Adult; Case-Control Studies; Cervical Ripening; Diabetes, Gestational; Diet, Diabetic; Female; Gestational Age; Humans; Hypoglycemic Agents; Labor, Induced; Meconium; Misoprostol; New Mexico; Oxytocics; Parturition; Pregnancy; Pregnancy Outcome; Retrospective Studies

A multigravida with gestational diabetes, mild pregnancy-induced hypertension and a previous curettage received four doses of misoprostol (100 microg) at three hourly intervals for induction of labor at term. Vaginal delivery of a live healthy baby occurred 1 h after the fourth dose. Hindwaters were bloodstained. Three hours later, she had excessive bleeding. Examination showed that the left lateral uterine wall had ruptured. She recovered after hysterectomy and blood transfusions.

Topics: Administration, Oral; Diabetes, Gestational; Female; Humans; Hypertension; Labor, Induced; Misoprostol; Oxytocics; Parity; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Factors; Uterine Rupture