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Diabetes and Pregnancy

, : Diabetes and Pregnancy. Zeitschrift für Geburtshilfe und Perinatologie 185(3): 125-136

The article reports on the experiences collected during treatment and delivery of 316 pregnant diabetic women hospitalized in the municipal hospital of Vienna-Lainz. 1. Close co-operation between diabetologist, obstetricians and pediatricians in imperative. 2. Early diagnosis and recording - as far as possible before conception -, accurate control and intensive care by the diabetologist and obstetrician right from the beginning is most essential; the aim should be to attain normoglycaemic levels preferably during the first 3 months of pregnancy. 3. In the case of diabetic patients requiring insulin who are difficult to stabilize, it would be desirable to effect stabilization in the hospital, followed by self-control of blood sugar levels with self-adjusted insulin variation. Above all, overweight should be avoided. 4. Obstetric intensive care can be effected only in a department with modern equipment. 5. In case of complications, it will always be necessary to provide for additional hospitalization over and above the routine cases; such hospitalization must always consist of combined obstetric and internistic medical care. 6. Prognostically Bad Signs of Pregnancy (PBSP) groups must be kept as small as possible. 7. Childbirth should be approximated as closely as possible to the calculated date of birth (in While A cases up to the 40th week of pregnancy, with the other patients at least up to the 38th week of pregnancy). The necessary controls which can justify postponing the time of birth, are explained. The approximation to the calculated data of birth depends largely on optimal stabilization of the diabetes to normoglycaemic levels during the entire pregnancy period. This is documented, inter alia, by normal weight of the newborn at the time of birth, corresponding to the duration of pregnancy. 8. Vaginal delivery should be aimed at. 9. Newborn are always high-risk infants; the first few minutes of live are absolutely decisive. The infants should be placed in the care of a team of pediatricians as early as possible, combined with transfer to a children's hospital with intensive-care ward, using an intensive-care ambulance for effecting the transfer. 10. These measures led to a reduction of the mortality rate (reduced to the corrected values), the average of which had been 12.5% during 1970-1971, to 1.85% during 1972-1979. The proportion of PBSP groups, which was originally 32.42%, dropped during the same period to 20.79%, the perinatal mortality in this group being reduced from 50% to 17.24%.


PMID: 7023085

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