A case-control comparison of the effectiveness of betamethasone to prevent neonatal morbidity and mortality in preterm twin and singleton pregnancies.

We compared the effectiveness of antenatal betamethasone for the prevention of neonatal morbidity and mortality in preterm twin and singleton gestations. We conducted a case-control study of women with twin versus singleton gestations who received betamethasone for risk of prematurity in a university-affiliated, community-based, tertiary care center between 1997 and 2005. Cases were identified from clinical care and pharmacy databases, then matched for neonatal gender and gestational age (GA) at delivery. Sixty cases and 60 controls of deliveries occurring between 24 and 34 weeks' gestation were identified. The mean GA was 30.4 +/- 2.7 weeks. There were no differences between the groups in maternal demographics (with the exception of maternal age), birth weight, head circumference, Apgar scores, need for mechanical ventilation, days on ventilator, intraventricular hemorrhage grade 3 or 4, necrotizing enterocolitis suspected sepsis, total days in neonatal intensive care unit, or neonatal deaths. No differences in major morbidities or mortality were found in singletons versus twins. Concerns that the added maternal plasma volume in multiple gestations could lessen the neonatal benefits of antenatal betamethasone were not substantiated. This study may be affected by beta-error due to small sample size and sampling bias as a result of a retrospective study.

Is transabdominal sonography of the cervix after voiding a reliable method of cervical length assessment?

OBJECTIVE: The purpose of this study was to assess the correlation and agreement between transvagi-nal and transabdominal cervical length measurement after bladder emptying as well as the feasibility of transabdominal sonography in cervical length screening. METHODS: This was a prospective cohort study involving 287 participants (14-34 weeks' gestation) from January to December 2003. After voiding, transabdominal and transvaginal cervical length measurements were obtained. The optimal trans-abdominal technique was established during an unblinded series of transabdominal and transvaginal cervical length measurements (n = 96). The same measurements were obtained in 191 participants under a blinded 2-sonographer protocol. The transabdominal cervical length cutoff to ensure 100% sensitivity in detecting a short cervix (

Fibrinolytic dysfunction after gestation is associated to components of insulin resistance and early type 2 diabetes in latino women with previous gestational diabetes.

Among patients with metabolic syndrome (MS), atherosclerosis and abnormal fibrinolytic function are frequently present, mostly owing to an increase in plasminogen activator inhibitor-1(PAI-1). We analyze PAI-1 in pregnant women, both normal and with gestational diabetes (GDM) and postpartum regarding its correlation to MS surrogates. Clinical characteristics, glucose tolerance (100g-OGTT), lipids, PAI-1 antigen, insulin sensitivity (HOMA-S), and pancreatic beta-cell function (HOMA-B) were investigated in 34 women. Eleven had normal glucose tolerance (NGT) during pregnancy and 23 had GDM (all GAD antibodies-negative). All patients were studied at 28-34 weeks of gestation and 16-24 weeks after delivery (75 g-OGTT). Parameters of interest were determined using commercial test systems. During pregnancy, PAI-1 was not statistically different between NGT and GDM (47+/-25 ng/ml versus 47+/-28 ng/ml, p=0.9). After gestation, 19 (56%) women had NGT (11 of them from previous NGT group) and 15 (44%) had impaired glucose tolerance (IGT) or DM. The IGT (IGT+DM) group had higher PAI-1 (p=0.01), which did not decreased after delivery NGT-NGT before and after delivery (47+/-25 ng/ml versus 6+/-5 ng/ml; p<0.001), GDM-NGT (62+/-36 ng/ml versus 14+/-15 ng/ml; p=0.001) and GDM-IGT (39+/-20 ng/ml versus 27+/-23 ng/ml; p=0.15). PAI-1 levels were positively correlated (p<0.05) to total cholesterol (r(s)=0.37), triglycerides (r(s)=0.48), fasting plasma glucose (r(s)=0.52), 2-h plasma glucose in the OGTT (r(s)=0.58) and were negatively correlated (p<0.05) with HOMA-S (r(s)=-0.42) and HOMA-B (r(s)=-0.38). Fibrinolytic dysfunction is still present in GDM women and is associated with early development of IGT or T2DM. PAI correlated with surrogate markers of MS levels and may identify a group of women at risk for macroangiopathy.

Uso da microalbuminúria em amostras urinárias aleatórias para o rastreamento de pré-eclâmpsia em grávidas diabéticas / Use of microalbuminuria in random urine samples to screen diabetic pregnant women for preeclampsia

OBJETIVO: avaliar o desempenho da dosagem de microalbuminúria como método para rastreamento de pré-eclampsia MÉTODOS: estudo prospectivo longitudinal no qual foram incluídas 45 grávidas diabéticas. Foi quantificada a microalbuminúria em três períodos distintos da gravidez: antes da 18ª semana, entre a 18ª e a 24ª semana e entre a 32ª e a 36ª semana de gravidez. Todas as pacientes freqüentaram o pré-natal entre janeiro de 2000 e dezembro de 2001. O ensaio de microalbuminúria/creatinina é método quantitativo para medir baixas concentraçöes de albumina, creatinina e a relaçäo albumina/creatinina na urina. Como critério indicativo de dano renal incipiente e risco para pré-eclâmpsia foi empregada a relaçäo albumina/creatinina maior que 16 mg/g. A sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da relaçäo albumina/creatinina foram calculados para predizer a ocorrência ou ausência de pré-eclâmpsia. RESULTADOS: do total de pacientes, 17 por cento apresentaram pré-eclâmpsia. A sensibilidade da relaçäo albumina/creatinina foi crescente de 12,5 por cento com 18 semanas para 25 por cento entre 18 e 24 semanas e 87 por cento após a 32ª semana. Em contraste, a especificidade teve valor decrescente de 97 para 89 e 83 por cento, respectivamente. O valor preditivo positivo foi relativamente baixo, com valores de 50, 33 e 53 por cento nos três diferentes períodos de avaliaçäo. De outro modo, o valor preditivo negativo foi elevado nas três faixas de idade gestacional, com valores de 83, 84 e 96 por cento. CONCLUSÖES: a quantificaçäo aleatória da microalbuminúria pôde predizer corretamente a näo ocorrência de pré-eclâmpsia em grávidas diabéticas, sendo pouco eficiente para a identificaçäo correta das pacientes que evoluíram com pré-eclâmpsia