Die Überwachung der Schwangerschaft bei Diabetes mellitus

Abstract

From 1970-1984 116 diabetic pregnant patients were monitored and delivered at the University Hospital of Freiburg, Department of Obstetrics and Gynaecology. The pregnant diabetics were managed and controlled by an interdisciplinary team of internists and obstetricians. For better control of the maternal metabolic status, the diabetic patients were admitted to the hospital three times during their pregnancy. Foetal monitoring was done by ultrasonography, hormone analyses and cardiotocography. In most cases foetal growth retardation and macrosomia were detected early via sonography. Decreased urinary excretion of total oestrogen was measured during late pregnancy in 13% of the diabetic patients. In cardiotocography a loss of foetal reactivity was observed in 11% of all non-stress tests (NST). In more than 50% of these cases, the total oestrogen excretion also decreased. In patients with normal oestrogen values, an abnormal NST was rarely observed. Abnormal oxytocin challenge tests (OCT) were recorded in 19% of the patients. Among these cases most of the patients with a non-reactive NST were found. In 85% of the patients with pathological changes in the OCT a Caesarean section had to be performed, and among these in all patients with a loss of foetal reactivity in the cardiotocogram. In correlation with the foetal outcome, loss of reactivity in the cardiotocogram has greater pathological relevance than deceleration with maintenance of reactivity. For an early recognition of imminent placental insufficiency, OCT proved to be the most sensitive parameter. The increased incidence of acute placental insufficiency in diabetics during delivery underlines the need for repeated stress tests during late pregnancy.

Die geburtshilfliche Betreuung diabetischer Schwangerschaften in Hessen 1982–1986

“…Der Schwerpunkt der perinatalen Mortalit/it von KDM liegt ante partum (3,J 7%), eine weiter verbesserte und intensivierte Oberwachung der diabetischen Schwangerschaft erscheint notwendig [5,6]. Der gegeniiber dem Restkollektiv erh6hte Anteil von Neugeborenen fiber 4000 g unter den KDM (21,1% vs. 9,4%) weist auf die Notwendigkeit engmaschig kontrollierter Stoffwechselftihrung und straffer metabolischer Einstellung bin, die auch die neonatale Mortalit/it gfinstig beeinflussen sollte [1,3,7].…”