Background:Untreated or poorly controlled gestational diabetes can cause serious complications for mother and newborn. Glibenclamide is rarely used in treating mothers with this disease. This study aimed at comparing the effect of glibenclamide and insulin on neonatal outcomes in women with gestational diabetes mellitus.Methods:In this randomized controlled clinical trial, 249 pregnant women aged 18–45 years within the 11th–33rd weeks of gestation with gestational diabetes, single fetus pregnancy, and in need of hyperglycemia treatment were entered and grouped randomly as either glibenclamide or insulin. In the insulin group (n = 129), insulin was administered with an initial dose of 0.2 IU/kg subcutaneously twice per day, whereas in the glibenclamide group (n = 120), 1.25 mg oral glibenclamide was administered once daily and increased if needed.Results:The results showed no significant difference in means age, gestational age, and body mass index between women in the two groups. In addition, there were no significant differences in the frequency of neonatal hypoglycemia, anomaly, hyperbilirubinemia, admission in Neonatal Intensive Care Unit (NICU), and neonatal respiratory distress between two groups. Macrosomia was lower in the glibenclamide group than the insulin group (3.3% vs. 13.2%, respectively, P = 0.005). Regression logistics model results showed that the type of treatment (odds ratio [OR]: 4.62; confidence interval [CI]: 1.45–14.02; P = 0.01) and gestational age at delivery (OR: 1.41; CI: 1.04–1.74; P = 0.01) were as predictor factors of macrosomia.Conclusions:The results of this study revealed that glibenclamide is able to reduce the risk of fetal macrosomia without increasing neonatal anomalies, jaundice, hypocalcemia, infant respiratory distress, and NICU admission.
Background:Measuring of maternal serum pregnancy-associated plasma protein-A (PAPP-A) in first trimester can be a way for early detection of adverse prenatal outcome due to faulty placenta.Objective:The aim was to Determination of association between placental thickness in second trimester with low level of PAPP-A in first trimester.Materials and Methods:In this cohort study, serum PAPP-A of 187 pregnant women was measured in the first trimester of pregnancy. Patients who had PAPP-A ≤0.8 MOM were in exposed and others who had PAPP-A >0.8 defined as unexposed group. The criteria of placental thickness in ultrasound study was thickness of 4 cm or more than 50% of placental length.Results:Of 187 patients, 87 patients had PAPP-A >0.8 and 93 patients had PAPP-A ≤0.8. Women with low levels of PAPP-A in the first trimester, had an increased incidence placental thickness of 34.4%, whereas another group had about 15% (p=0.002). Also, PAPP-A levels had acceptable sensitivity and specificity for placental thickness detection (71.1% and 54.8%, respectively. Conclusion:Our study showed that serum level of PAPP-A generally was low (≤0.8) in women with a thick placenta (>4 cm or >50% of placental length). The first trimester of pregnancy measurement of PAPP-A will be more predictable for healthy placenta.
To compare the efficacy and complications of intravaginal Misoprostol with oxytocin for induction of labor this study was carried out. One hundred and ten term pregnant women with Bishop score of < or = 4 were randomized into two groups. Fifty five patients received 50 microg intravaginal Misoprostol 2 times at 6 h intervals (Misoprostol group), the second group received oxytocin infusion (6 mu min(-1)) for induction of labor (oxytocin group n = 55). The time from induction to delivery, the route of delivery, fetal outcome and maternal complications were recorded. There was no statistically significant difference regarding demographic or clinical characteristics between two groups. Induction success within the first 12 h were 80 and 33.3% for Misoprostol and oxytocin groups respectively (p<0.05). The average time from induction to delivery was 10. 6 +/- 3.7 and 17 +/- 7.2 h in the Misoprostol and oxytocin administered groups, respectively (p<0.05). The rate of vaginal delivery was significantly higher in misoprostol group (72.7%) when compared with oxytocin group (45.5%). Low Apgar score, meconium stain amniotic fluid, abnormal FHR and precipitating labor was similar in both groups (p>0.05). We concluded misoprostol 50 microg vaginally (every 6 h, up to 100 microg) safely and effectively induces labor and it is recommended for parturient women with Bishop score < or = 4 and the use of this drug could produce several beneficial effects, particularly a decrease in the incidence of cesarean delivery.
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