Gestational diabetes
Nadia Barghouthi, Jessica Perini in Endocrine Diseases in Pregnancy and the Postpartum Period, 2021
Gestational diabetes mellitus (GDM) is common and, if untreated, poses a risk to the mother and fetus. Clinical trial data regarding these risks inform screening strategies and treatment guidelines. Universal screening for GDM between gestational weeks 24 and 28 is now recommended in the US. Earlier gestational screening for preexisting type II DM is considered in higher-risk pregnancies. Lifestyle measures including diet, weight loss, and exercise suffice to treat the vast majority of patients with GDM. Pharmacotherapy options for those failing lifestyle measures include insulin, metformin, and glyburide, although controversy regarding the optimal pharmacologic treatment persists and guidelines vary. Postpartum diabetes frequently follows GDM and guidelines provide protocols for diabetes prevention and follow-up.
Gestational trophoblastic disease
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng in Diagnostic Endometrial Pathology, 2019
The diagnosis of gestational trophoblastic disease has witnessed revolutionary changes with improved availability of immunohistochemistry and genotyping as valuable adjuncts. The term ‘gestational trophoblastic disease’ can be viewed as comprising three groups of conditions. The first group is made up of gestations with morphologic abnormalities in the chorionic villi and variable extent of trophoblastic proliferations, mostly related to the underlying genomic constitutions. The second group is trophoblastic tumors, which include choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor. The third group is non-neoplastic trophoblastic lesions, mainly comprising exaggerated placental site and placental site nodule, together with some rare lesions that are being characterised. Hydatidiform moles are genetically abnormal conceptions with excessive paternal contribution to the fetal genomes. The histologic features of complete hydatidiform mole vary with the gestational age. Gestational choriocarcinoma grossly manifests as a bulky mass in the uterine corpus with hemorrhage and necrosis on its cut surface.
Assisted reproduction and embryo research
Marc Stauch, Kay Wheat in Text, Cases and Materials on Medical Law and Ethics, 2018
This chapter explores in more detail the specific solutions adopted by the law in relation to the key areas of licensed fertility treatment. It focuses on in vitro fertilisation (IVF) treatment involving the creation of an embryo ex vivo to be implanted in a woman's uterus for gestation. The chapter returns to the field of assisted reproduction, but move on to address the additional complexities that arise when third party gamete providers are introduced into the picture by procedures such as artificial insemination by donor ('DI') and egg donation. It looks at one area where such third-party involvement in reproduction has aroused particular controversy, namely surrogacy, in which a woman makes use of her gestational capacity to carry a child for others. The technique, long sought, at last successful, opened up new horizons in the alleviation of infertility and in the science of embryology.
Serum chemerin level during the first trimester of pregnancy and the risk of gestational diabetes mellitus
Published in Gynecological Endocrinology, 2017
Xuezhou Yang, Xiaozhen Quan, Yanli Lan, Jinhai Ye, Qipeng Wei, Xiaofang Yin, Fangfang Fan, Hui Xing
Objective: To investigate the association between chemerin level in the first trimester of pregnancy and the risk of gestational diabetes mellitus. Methods: The blood samples of 212 women at 8–12 weeks of gestation were collected. After screening for gestational diabetes mellitus (GDM), 19 women with GDM and 20 women randomly selected from 144 women with normal glucose tolerance (NGT) were included in the study. Blood samples were collected from these women. Triglycerides, glucose, total cholesterol, and HDL cholesterol, LDL cholesterol, insulin and chemerin were measured. Gestational weight gain and body mass index was assessed. Results: Serum levels of chemerin were significantly elevated during late gestation, and the risk of GDM was positively associated with maternal serum chemerin in the first trimester. Conclusion: Serum chemerin level during the first trimester of pregnancy has the potential to predict risk of GDM.
Duration of labor by gestational week in nulliparous women
Published in The Journal of Maternal-Fetal & Neonatal Medicine, 2014
Samuel Lurie, Yana Vinnikov, Mona Boaz, Abraham Golan, Oscar Sadan
Objectives: To assess whether labor length differs by week of gestation. Methods: In this observational cross-sectional study, we compared duration of labor by gestational age (36 + 0 through 40 + 6 weeks) in primiparous singleton parturients with vertex presentation. Data were acquired for a period of 24 months (2010–2011). Results: In general, the rate of change in cervical dilatation decreased as gestational week at delivery advanced: 1.8 ± 1.0 cm/h, 1.5 ± 0.9 cm/h, 1.3 ± 0.8 cm/h, 1.6 ± 1.5, and 1.3 ± 1.0 cm/h at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.040). Concurrently, the total labor duration (1st + 2nd + 3rd stages) increased as gestational age advanced: 423.6 ± 180.9 min, 496.5 ± 212.6 min, 545.9 ± 247.1 min, 483.8 ± 256.3 min, and 568.2 ± 273.8 min at 36th, 37th, 38th, 39th and 40th gestational week, respectively (p = 0.013). Conclusions: Gestational week of pregnancy may alter the duration of labor, specifically, the length of labor increases as gestational week at delivery advances.
Change of Pulsatility Index of the Fetal Middle Cerebral Artery after Auditory Stimulation in No Risk Pregnancies and in Pregnancies with Gestational Hypertension
Published in Clinical and Experimental Hypertension, 2013
Snezana Plesinac, Svetlana Jankovic, Darko Plecas, Olga Antonovic, Tatijana Adamovic, Mirjana Sovilj
Purpose: An aim was to determine the degree and the mode of variation of PI of middle cerebral artery in no risk pregnancies and in pregnancies with gestational hypertension, after the constant sound stimuli. Method: Study included 343 patients divided in two groups. Group 1: low risk pregnancies and group 2: gestational hypertension. Ultrasound prenatal auditory screening was performed after the 27th week of gestation. Results: The percentage of fetuses with increase of cerebral blood flow was slightly higher in the pregnancies with hypertension. Conclusion: An average change of PI of median cerebral artery was higher in this group.