The objective of this study was to determine if the 2 h value of the glucose tolerance test (GTT) is as reliable as the complete GTT in identifying risk for excessive fetal growth. Five hundred eighty-eight patients underwent a 3 h oral GTT at 26-28 weeks' gestation. The 2 h value of the test was compared to the results of the GTT. The incidence of large for gestational age (LGA) infants was compared for patients who had an abnormal GTT or an abnormal 2 h value only. A normal 2 h value was associated with a normal GTT in 98.5% of cases, while an abnormal 2 h value was associated with an abnormal GTT in 70% of cases. An abnormal GTT was associated with a 22% incidence of LGA, while a 2 h value > or = 165 mgm/dl was associated with a 20% incidence of LGA. This difference was not statistically significant. A single 2 h value GTT is more cost-effective and as predictive as a complete 3 h GTT in identifying risk for excessive fetal growth.

Blood Glucose↗

PubMedDate not supplied

Does labetalol predispose to pulmonary edema in severe pregnancy-induced hypertensive disease?

We investigated whether use of labetalol, a beta adrenoreceptor blocking antihypertensive agent commonly employed as an alternative to hydralazine, is independently associated with pulmonary edema in women with severe preeclampsia. We retrospectively evaluated women with severe preeclampsia who were given labetalol by intravenous bolus for MAP > 120 mm Hg. Outcome variables included: achieving MAP < 120 mm Hg with < 300 mg of labetalol, incidence of adverse effects of the drug, including pulmonary edema, hypotension, and maternal bradycardia. Total intravenous fluid intake exceeding output (+ delta I/O) and presence or absence of preeclamptic liver involvement were noted. Statistical analysis included unpaired t-tests and Fisher's exact test. Fifty-one women were studied, 7 (13.7%) of whom developed pulmonary edema. Demographic and pregnancy characteristics were not different between patients who did or did not develop pulmonary edema. No patient had detectable underlying heart disease. Patients with or without pulmonary edema did not differ as regards entry MAP (130 +/- 14 vs. 129 +/- 18 mm Hg), total dose of labetalol (209 +/- 83 vs. 193 +/- 39 mg/24 hours), incidence of bradycardia or hypotension (0/7 vs. 8/44), or presence of hepatic involvement (1/7 vs. 9/44). However, there was a significant difference in degree of positive fluid balance. Patients developing pulmonary edema had a net gain of 1,466 +/- 429 mL of fluid in the 24 hours in which they received labetalol than those who did not (659 +/- 1152 mL, P = .003). Initial central hemodynamic monitoring data revealed no impairment of cardiac performance (mean cardiac output 7.7 +/- 1.8 L/min, cardiac index 4.0 +/- 0.8 L/min/m2, left ventricular stroke work index 73 +/- 9 g.m.m-2) despite high pulmonary capillary wedge pressures (22 +/- 4 mm Hg). We conclude that the incidence of pulmonary edema in patients with severe preeclampsia who are treated with labetalol appears to be a result of an increase in third space fluid accumulation as a manifestation of the severity of their disease, not a direct effect of the drug on cardiac performance.

Adult↗

PubMedDate not supplied

Early transvaginal sonographic diagnosis of gastroschisis.

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Abdominal Muscles↗

PubMedDate not supplied

Pregnancy complicating ambulatory patient management of diabetes.

Two groups of patients are summarized. The first group demonstrates contemporary perinatal outcome using a predominantly outpatient management plan. The second group demonstrates extension of the outpatient management using a reflectance meter for in-the-home blood glucose assessments. The financial savings of outpatient management is emphasized.

Ambulatory Care↗

PubMedDate not supplied

Relative effects of antepartum and intrapartum maternal blood glucose levels on incidence of neonatal hypoglycemia.

OBJECTIVE: The objective of this study was to compare the relative effects of both antepartum and intrapartum maternal plasma glucose concentrations on neonatal plasma glucose levels. STUDY DESIGN: This was a prospective, nonrandomized study. Two hundred thirty-three pregnant insulin-requiring patients with diabetes received intensive diabetic treatment aimed at maintaining the 2-hour postprandial plasma glucose level < 150 mg/dl and the intrapartum plasma glucose level < 100 mg/dl. The neonatal plasma glucose level was monitored during the first 48 hours of life and the incidence of neonatal hypoglycemia was compared with the average antepartum and intrapartum maternal plasma glucose concentrations. RESULTS: The lowest incidence of neonatal hypoglycemia occurred, as expected, among infants of patients who had the lowest mean antepartum and intrapartum plasma glucose levels. However, the intrapartum plasma glucose concentration had a stronger association with decreased neonatal hypoglycemia than the antepartum plasma glucose levels. CONCLUSIONS: Even in the presence of poor antepartum diabetic control tight regulation of the intrapartum plasma glucose levels will significantly reduce the incidence of neonatal hypoglycemia.

Blood Glucose↗