Ambulatory arterial stiffness index in type 1 diabetes mellitus: any different during pregnancy?

OBJECTIVE: To analyze the ambulatory arterial stiffness index (AASI) and pulse pressure (PP) during pregnancy and 3 months after delivery in type 1 diabetes mellitus (T1DM) and compare it to healthy pregnant controls. STUDY DESIGN: Prospective, descriptive study of 59 women with T1DM and 42 non-diabetic women. Blood pressure was measured using a portable oscillometry monitor and AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure obtained from 24-h monitoring. Main outcome measures were comparisons of the AASI and PP between T1DM women and controls examined during pregnancy, and of the AASI and PP during and after pregnancy in T1DM women. RESULTS: PP and AASI were higher at all times during pregnancy in T1DM compared to postpartum (p<0.01). AASI and PP were significantly associated with albumin excretion rate when adjusting for retinopathy, preeclampsia, duration of diabetes, HbA1c, age, and BMI. The AASI was positively correlated with night-day ratio in the 1st and 3rd trimesters during pregnancy. No difference was found in AASI compared with non-diabetic controls during pregnancy. CONCLUSIONS: AASI and PP increased during diabetic pregnancy and were associated with the women's albuminuria grade.

[Defect at uterine incision from prior Caesarean section]. / Defekt i uterotomi efter tidligere sectio.

A case of asymptomatic uterine fenestration in 26+3 gestational weeks in a patient who had previously undergone Caesarean section is presented. Controls were planned. In gestational week 34+1 the woman was hospitalized due to lower abdominal pain, but with otherwise normal objective parameters. Ten days later the patient had increasing pain, and a caesarean section was performed. Fenestration was confirmed. This leads to reflections on how to treat and observe such cases, and further discussion about whether early identification of risk patients by ultrasound is possible.

Night/day ratio as predictor of preeclampsia in normoalbuminuric, diabetic women: early signs of blood pressure disorders.

PURPOSE: Day/night ratio from diurnal ambulatory blood pressure (AMBP) in pregnant women with type 1 diabetes mellitus (T1DM) and in non-diabetic women was evaluated for its association with preeclampsia, retinopathy, HbA1c, and birth weight. METHODS: One hundred and sixty-one women were recruited for AMBP performed with a Spacelab 90207 monitor. The pregnant women were 50 non-diabetic women and 111 T1DM women with normoalbuminuria and no hypertension. ANOVA, regression, and ROC curves analysis were applied. RESULTS: Women with simplex retinopathy had higher night/day ratio and lower birth weight than those without retinopathy. Women who developed preeclampsia had night/day ratio similar to those with simplex retinopathy. In first trimester they had higher blood pressure than those who did not develop preeclampsia. CONCLUSIONS: Simplex retinopathy and preeclampsia are associated with a reduced night/day ratio even with normal blood pressure but night/day ratio provides no better prediction of preeclampsia than the absolute values.

Massive fetomaternal hemorrhage: clearance of fetal red blood cells after intravenous anti-D prophylaxis monitored by flow cytometry.

BACKGROUND: The clearance of D+ red blood cells (RBCs) from the circulation in D- individuals mediated by passively administered anti-D occurs by opsonization with the antibody and subsequent removal in the spleen. Few data exist on the kinetics of clearance of large volumes of D+ RBCs from the maternal circulation by anti-D in clinical cases of massive fetomaternal hemorrhage (FMH). CASE REPORT: A 33-year-old D- woman delivered a D+ female infant by emergency cesarean section for suspected fetal anemia. A massive FMH, initially estimated to be approximately 142 mL of RBCs, was found. In addition to the standard dose of intramuscular (IM) anti-D (300 microg) given immediately after delivery, 2700 microg of anti-D was administered intravenously (IV). The clearance of D+ fetal cells from the maternal circulation was monitored by flow cytometry in samples obtained on a daily basis using anti-D. The mother had no detectable anti-D 6 months after delivery. RESULTS: No clearance of fetal cells was apparent after the insufficient dose of IM anti-D. The IV administration of anti-D caused accelerated clearance of D+ fetal RBCs with a t1/2 of 24.5 hours. D+ reticulocytes comprised 4.2 percent of all D+ cells in the maternal circulation at delivery suggesting acute fetal blood loss. CONCLUSIONS: The approach used in this report allowed a detailed analysis of the kinetics related to the clearance of fetal D+ RBCs. Simultaneous measurements of fetal reticulocytes and fetal RBCs in maternal blood may establish the timing of an FMH.

Precision, consistency, and reproducibility of blood pressure in diabetic and non-diabetic pregnancy: the appraisal of repeated measurements.

A monitor (Spacelab 90207) was compared with sphygmomanometric blood pressure (BP) with respect to reproducibility and variations on precision and consistency. Some 133 women with type 1 diabetes mellitus and 59 non-diabetic women were recruited. During pregnancy, systolic BP was between 6 and 12 mmHg higher in the oscillometric than the auscultatory readings, and diastolic BP was between 1 and 2.6 mmHg. The association of difference with the mean BP disappeared with progression of pregnancy and the repetition of measurements in diabetic pregnancy. The precision, reproducibility, and trend of association over the scale of measurement were improved in the repeated compared to individual measurements, whereas consistency did not improve.