A very low percentage of patients satisfied all criteria for valid use of ΔPP in the evaluation of fluid responsiveness. Physicians must consider limitations to the validity of ΔPP before using this variable.

Prenatal ultrasonographic (US) detection of congenital adenomatoid malformation (CAM) was made in 18 fetuses at 17 - 36 weeks' gestation and managed in our institution during a 10-year period (1985-1994). The lesion was left-sided in 13 cases, right-sided in 4, and bilateral in 1. According to Stocker's classification, 12 cases were type I, 4 type II, and 2 type III. The prenatal course was followed with serial US examinations in 13 cases; the size of the lesion was stable in 8 and decreased in 5. Mediastinal shift was usually observed, and amniotic fluid volume was increased in 4 cases. One fetus was aborted. Six infants presented with respiratory distress syndrome and required neonatal surgery; delayed surgery was performed in 9 cases. Spontaneous regression of the lesion was observed on follow-up in 2 cases. Surgery consisted in lobectomy in 8 cases and segmentectomy in 6. The presence of fetal hydrops, type III lesions, and bilateral lung involvement are prenatal factors known to be associated with a poor prognosis. However, this series and a review of the literature suggest that caution should be observed with regard to the initial impression when counseling the parents regarding prognosis.

OBJECTIVE -To evaluate perinatal outcome in pregnancies in women with type 1 and type 2 diabetes and the influence of preconception care 10 years after the St. Vincent's declaration. RESEARCH DESIGN AND METHODS-A cross-sectional study was conducted in 12 perinatal centers in France in 2000 -2001. The main investigated outcomes were perinatal mortality, major congenital malformations, and preterm delivery.RESULTS -Among 435 single pregnancies, 289 (66.4%) were from women with type 1 and 146 (33.6%) from women with type 2 diabetes. Perinatal mortality rate was 4.4% (0.7% national rate), severe congenital malformations rate was 4.1% (2.2% national rate), and preterm delivery rate was 38.2% (4.7% national rate). Preconception care was provided in 48.5% women with type 1 diabetes and in 24.0% women with type 2 diabetes. Women whose first trimester HbA 1c was Ͼ8% had higher rates of perinatal mortality (9.2 vs. 2.5%; odds ratio 3.9; 95% CI 1.5-9.7; P Ͻ 0.005), major congenital malformations (8.3 vs. 2.5%; 3.5; 1.3-8.9; P Ͻ 0.01), and preterm delivery (57.6 vs. 24.8%; 1.4; 1.1-1.7; P Ͻ 0.005) than those with first trimester HbA 1c Ͻ8%. These results are similar to those reported in France in 1986 -1988.CONCLUSIONS -Pregnancies in women with diabetes are still poorly planned and complicated by higher rates of perinatal mortality and major congenital malformations. Despite knowledge of the importance of intensified glycemic control before pregnancy, reaching the St. Vincent's target needs further implementation in France. Diabetes Care 26:2990 -2993, 2003I n 1989, representatives of the government health departments and patients' organizations from all of the European countries met with diabetes experts under the aegis of the Regional Offices of the World Health Organization and the International Diabetes Federation in St. Vincent, Italy, and identified goals to be achieved in the treatment of diabetes (1). One of the declared aims was that within 5 years, "pregnancy outcome of diabetic women should approximate that of the nondiabetic women." Previous studies have shown that such results may be obtained in women with type 1 diabetes by providing effective preconception care and intensive support to improve glycemic control before and during the whole pregnancy (2-5). However, this was achieved in selected populations and in specialized units. By contrast, several surveys done in nonselected, geographically based populations showed that the prognosis of pregnancy in women with type 1 diabetes remains poorer than that of the general population (6,7). Moreover, new issues have been raised by the increasing prevalence of type 2 diabetes in pregnancy (8). Particularly, type 2 diabetes often remains unrecognized, and the rate of perinatal mortality in women with type 2 diabetes may be higher than in those with type 1 diabetes (9).In 1986 -1988, a multicenter survey of pregnancies in women with diabetes was performed in France (10). It essentially showed that the rate of perinatal mortality was 1.9% in women with type 1 diabete...

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