SUMMARY Aortic dissection occurred in a nineteen year old woman during the thirty seventh week of pregnancy. Immediate elective delivery of a normal baby by caesarean section was followed by aortic root replacement 48 hours later. It was decided not to proceed immediately to operation on the aortic root because it was believed that the anticoagulation necessary for cardiopulmonary bypass might provoke dangerous haemorrhage from the raw placental site. Case reportA nineteen year old woma-n booked in for her first pregnancy at the local hospital. She remained well and fetal growth was normal until the thirty seventh week when she complained to her general practitioner of dizziness and a discomfort in her neck and chest radiating through to her back. Clinical examination at that time was normal. Two days later, however, her husband noted vibration in her chest and the family doctor confirmed the presence of new cardiac murmurs.She was admitted to the local district hospital, and one week later was referred to the regional centre. On admission she had mild chest discomfort and tiredness. Clinical examination showed no signs of heart failure. She was normotensive with a blood pressure in both arms of 105/55 mmHg. A systolic thrill was present to the right of the upper part of the stemum, and on auscultation an ejection systolic and early diastolic murmur were heard.A chest radiograph showed an enlarged cardiac shadow but the upper mediastinum was normal (Fig. 1). The electrocardiogram was normal. Cross sectional ultrasound examination showed that the aortic root was 7 cm in diameter; in the short axis view the aortic root was shown to consist of a normal sized main lumen with a large false lumen on the right side (Fig. 2).
@ Institute of Obstetrics and Gynaecology Trust, 1991 J Obstet Gynaecol Downloaded from informahealthcare.com by Mcgill University on 11/17/14 For personal use only. Yudkin P. L., Aboualfa M., Eyre J. A., Redman C. W. G. and Wilkinson A. R. (1987) New birthweight and head circumference centiles for gestational ages 24 to 42 weeks. Early Human Development 15,
A retrospective study was conducted to assess glycaemic control in relation to pregnancy outcomes in pre-existing and gestational diabetics. Computerised blood glucose records from 47 pre-existing diabetic patients and 33 gestational diabetics were collected prospectively and then analysed retrospectively in relation to pregnancy outcomes. There were two spontaneous miscarriages from the pre-existing diabetic cohort. A total of 44,279 individual blood glucose estimations were made. The mean fasting glucose for pre-existing diabetic patients fell significantly throughout pregnancy, being 7.7+/-2.1, 7.2+/-3.1 and 6.5+/-2.4 mmol/l, respectively, for trimesters 1,2 and 3 (P<0.01). The mean post-prandial glucose for each trimester were 8.9+/-2.0, 8.6+/-1.6 and 8.2+/-1.2 mmol/l (P<0.01). The HbAlc for pre-existing diabetic patients for each trimester was 7.5+/-1.4%, 6.1+/-1.0% and 5.9+/-0.7%, respectively. Gestational diabetic patients had a mean fasting glucose of 5.6+/-1.5 mmol/l and a mean post-prandial glucose of 8.0+/-2.1 mmol/l during trimester 3. Home glucose monitoring correlated reasonably well with first trimester HbA1c (r2=0.43, P<0.001), but this relationship became less valid as pregnancy progressed. The mean gestation at delivery was 37 weeks, although 30% of women were delivered between 34 and 37 weeks and 8% delivered before 34 weeks. Labour was induced in 49% of patients and the overall caesarean section rate was 58%. The mean birth weight for pre-existing diabetic patients was 3479 g (1410-5000 g) and for women with gestational diabetes was 3605 g (1890-5920 g). For pre-existing diabetic patients HbA1c did not correlate with birth weight; however, home blood glucose data from trimester 2 did correlate (r2=0.15, P <0.005) and there appeared to be stronger relationship with trimester 3 data (r2=0.24, P <0.005). There was no association between trimester 3 glucose data and birth weight in the gestational cohort. The babies born to pre-existing diabetic mothers had a high incidence of admission to a neonatal unit and over 50% of the babies had proven hypoglycaemia. Our present computerised system for home blood glucose monitoring has shown that for pre-existing diabetes patients but not gestational diabetic patients, glycaemic control in the second and third trimester influences birth weight. The current degree of glycaemic control in the mothers did not prevent a high rate of neonatal hypoglycaemia.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.