To evaluate the outcome of pregnancy in diabetic women who had an episode of ketoacidosis during gestation, 20 consecutive cases of ketoacidosis in type I diabetic pregnant women were studied. They were divided into two groups for comparison: Group 1, 13 patients (65%), had a live fetus and group 2, seven patients (35%), had a fetal death on admission. Both groups were similar in age, gravidity, parity, abortions, height, weight, serum sodium and potassium, arterial pH, carbon dioxide tension, bicarbonate, base excess, and anion gap. Significantly different between groups 1 and 2 were: gestational age (24 versus 31 weeks; p < 0.05), serum glucose (374 versus 830 mg/dl; p < 0.005), blood urea nitrogen (14 versus 23 mg/dl; p < 0.025), osmolality (295 versus 311 mmol/kg; p < 0.025), insulin requirements (127 versus 202 U; p < 0.05), and length of resolution (28 versus 38 hours; p < 0.05). Two patients had serum glucoses less than 200 mg/dl despite profound ketoacidosis. Precipitating factors included infections, poor compliance, and very importantly, unrecognized new onset of diabetes (6 patients). All stillborns were grossly normal and those autopsied had no discernible cause of death. There were no maternal deaths. A high fetal mortality (35%) was found but there were no fetal losses once therapy was initiated. The unrecognized new onset diabetics accounted for almost a third (30%) of the cases of ketoacidosis and for 57% of the fetal deaths. Attentiveness to the symptoms of uncontrolled diabetes and appropriate screening can be effective preventive measures.

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Hereditary factor X deficiency represents an uncommon challenge in pregnancy. A 30-year-old primigravida affected by severe factor X deficiency was followed from 6 weeks of gestation until delivery. Factor X was provided prior to delivery for the first time in pregnancy via plasma exchange. The pregnancy and postpartum period were not complicated by bleeding episodes; therefore this approach was accompanied by lower cost and fewer side effects when compared with fresh-frozen plasma and prothrombin complex concentrates infusion, two therapeutic options already used in pregnancy.

Malignancies, even those as uncommon as primary synovial sarcoma, should be considered in the differential diagnosis of pneumothorax during pregnancy.

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