RESUMEN
Background: Type 1 and type 2 diabetes during pregnancy requires intensive glucose monitoring to ensure optimal health outcomes for mothers and infants. Standard practice includes patients monitoring their glucose four to six times a day using a standard glucometer and paper diary. Remote patient monitoring (RPM) offers an alternative method for diabetes management. This study aimed at measuring the patient's satisfaction with and feasibility of using a cellular-enabled RPM device for glucose management in pregnancies complicated by type 1 or type 2 diabetes. Methods: In a mixed-methods pilot study, 59 pregnant women with type 1 or type 2 diabetes were given a cellular-enabled iGlucose glucometer. Participants completed a pre-survey, used the device for 30 days, and then completed a post-survey and semi-structured interview. Results: Participants were divided into two groups based on duration of device use: high-use >50 days and low-use ≤50 days. A significant difference (p < 0.0001) in Appraisal of Diabetes scores was seen between the pre- and post-survey for both groups, which indicates that the use of iGlucose glucometer significantly improved participants' appraisal of their diabetes. There was a significant difference (p = 0.0409) in pre-post General Life Satisfaction in the high-use group, which indicates that iGlucose glucometer significantly improved participants' life satisfaction when used for an extended amount of time. Participants scored high on system usability for all groups and reported positive associations with iGlucose use. Conclusion: The use of cellular-enabled RPM glucometers is a valuable tool for the management of type 1 diabetes mellitus and type 2 diabetes mellitus during pregnancy.
RESUMEN
Importance: Adrenal hemorrhage in pregnancy is rare. The prevalence of pregnant patients whose pregnancies are complicated by preeclampsia or eclampsia is hypothesized to be slightly higher than the 0.4% to 1.1% occurrence rate in the nonpregnant population. However, the mortality rate of adrenal hemorrhage is reportedly as high as 15%. Therefore, it is critical for obstetric providers to have basic knowledge on the presentation, diagnosis, and management of adrenal hemorrhage in the pregnant population so that prompt diagnosis can be made. Objective: This review highlights incidence, pathophysiology, risk factors, diagnosis, management, and complications of adrenal hemorrhage in the peripartum period. Evidence Acquisition: A literature search was undertaken by our research university librarian using the search engines of PubMed, CINAHL, and EMBASE (Medline items removed). The search terms used included "adrenal hemorrhage" OR "adrenal gland hemorrhage" AND "pregnancy" OR "maternal." The search was limited to articles in English, and the years searched were from January 1, 2015 to December 31, 2021. Results: There were 130 abstracts identified, and 30 of the articles were ultimately used as the basis for this review. Presenting signs and symptoms of adrenal hemorrhage were typically abdominal, back, and flank pain. Diagnosis was typically made with ultrasound and computed tomography or magnetic resonance imaging without contrast for confirmation. Management options include conservative management versus surgical management with adrenalectomy or interventional radiology embolization in the unstable patient. For patients with evidence of adrenal insufficiency, steroid replacement was used. Most patients with adrenal hemorrhage in the literature had unilateral adrenal hemorrhage; however, several cases of bilateral adrenal hemorrhage have been reported. Patients with bilateral adrenal hemorrhage were more likely to require steroids for adrenal insufficiency. There are no known contraindications to vaginal delivery in this group of patients, and patients who were managed conservatively were often able to continue the pregnancy to term. Conclusions: Early recognition and management are integral in decreasing the morbidity and mortality associated with adrenal hemorrhage. Relevance Statement: This is an evidence-based review of adrenal hemorrhage in pregnancy and how to diagnose and manage a pregnancy complicated by adrenal hemorrhage.
