Obstetrical outcomes in patients with early onset gestational diabetes.

OBJECTIVE: The objective of this study was to characterize patients with early onset gestational diabetes and compare outcomes to patients diagnosed with standard gestational diabetes and pregestational diabetes. METHODS: This is a retrospective cohort study of patients diagnosed with gestational or pregestational diabetes. All patients received a glucose challenge test at their first prenatal visit to diagnose early onset gestational diabetes and were recommended to have postpartum glucose tolerance tests to detect undiagnosed type 2 diabetes. Outcomes were compared between patients with early onset gestational diabetes and both standard gestational diabetes and pregestational diabetes with p < 0.05 was used for significance. RESULTS: Four hundred and twenty-four patients met the inclusion criteria. Nine percent of the patients with early onset gestational diabetes were found to have undiagnosed type 2 diabetes based on postpartum testing and 91% to have resolution in the postpartum period. No patient with early onset gestational diabetes and resolution in the postpartum period had abnormal screening for renal or ophthalmologic disease, but 5% had abnormal fetal echocardiograms. These patients were more likely to require pharmacotherapy for glycemic control than patients with standard gestational diabetes and less likely than patients with pregestational diabetes (55% versus 39% versus 81%). CONCLUSION: Most patients diagnosed with early onset gestational diabetes do not have undiagnosed type 2 diabetes but do have unique characteristics and obstetrical outcomes.

Mixoploidy: perinatal diagnosis and pregnancy outcome.

Mixoploidy is rare chromosomal disorder characterized by multiple cell lines, usually including triploidy, within tissues. Pregnancy outcome has generally been considered poor with congenital anomalies and developmental delay reported in postnatally diagnosed cases. We report on two cases of abnormal midtrimester ultrasound showing placental abnormalities. Karyotype assessment showed mixoploidy, and both cases had satisfactory pregnancy outcome.

Eikenella corrodens chorioamnionitis: modes of infection?

We report a case of preterm labor caused by Eikenella corrodens chorioamnionitis at 26 weeks of gestation. The patient and her partner had tongue piercing and had daily mutual oral intercourse. Hematogenous spread from repeated trauma to tongue piercing and ascending vaginal infection are possible routes for E corrodens intraamniotic infection.

Structuring healthcare knowledge bases: an analysis of explicit and implicit structures in Arden Syntax and an XML schema representation of Arden Syntax.

The Arden Syntax for Medical Logic Modules (MLMs) is an ANSI and ISO recognized standard language for representing clinical knowledge bases. We analyzed the explicit and implicit structures in Arden Syntax MLMs and developed an information model represented as an XML schema. While the explicit structures were easily represented as XML, implicit structures require further explicit definition. In any future representation format, explicit structuring must be balanced with expressiveness and usability.

Family-oriented cardiac risk estimator: a Java web-based applet.

We developed a Java applet that calculates four different estimates of a person's 10-year risk for heart attack: (1) Estimate based on Framingham equation (2) Framingham equation estimate modified by C-reactive protein (CRP) level (3) Framingham estimate modified by family history of heart disease in parents or siblings (4) Framingham estimate modified by both CRP and family heart disease history. This web-based, family-oriented cardiac risk estimator uniquely considers family history and CRP while estimating risk.