Short-term neonatal outcome in diabetic versus non-diabetic pregnancies complicated by non-reassuring foetal heart rate tracings.

OBJECTIVE: Analysis of the impact of non-reassuring foetal heart rate patterns (FHR) and suspected foetal distress during active labour on the neonatal outcome in diabetic compared to non-diabetic mothers. METHODS: Retrospective case-control study comparing the short-term neonatal outcome including Apgar score at 5 min, and arterial/venous umbilical cord blood pH of 57 deliveries of women with different types of diabetes and 114 healthy controls. Patients were selected out of all deliveries with suspected foetal distress during active labour and performed foetal scalp pH samplings (n = 590) at the Medical University of Graz, Austria, during 2008-2009. RESULTS: Arterial pH was significantly lower in the diabetic group (7.215 versus 7.250, p = 0.007). Apgar scores ( > 8) at 5 min were similar in both groups (96.5% versus 95.6%, p = 0.566). The percentage of cases with foetal scalp blood pH <7.25 was higher in the diabetes group, but did not reach statistical significance (14.1% versus 7.1%, p = 0.166). CONCLUSIONS: Newborns of women with gestational and type 1 diabetes and non-reassuring FHR tracing have significantly lower arterial cord blood pH values without consequences on neonatal postpartum adaptation. Special attention to pathological changes in FHR patterns and to the more rapid decline in foetal pH during periods of foetal distress may be warranted in women with gestational and pre-conceptional diabetes during active labour. More frequent foetal scalp pH testing to rule out clinically relevant foetal acidosis needs to be discussed.

Efficacy of misoprostol in relation to uterine position in the treatment of early pregnancy failure.

OBJECTIVE: To evaluate the efficacy of misoprostol in the treatment of missed or incomplete abortion in relation to uterine position. METHODS: In a retrospective cohort study, misoprostol was evaluated as first-line treatment for missed and incomplete abortion before 13 gestational weeks. Between 2009 and 2011, women received 600 µg of sublingual misoprostol for missed abortion or 400 µg for incomplete abortion. Follow-up examinations were performed 7-10 days later, with the option of a second administration of misoprostol. Success was defined by the absence of vaginal bleeding or sonographic signs of incomplete abortion, and falling levels of ß-human chorionic gonadotropin. RESULTS: In total, 111 women were included in the study. A single-dose regimen was effective for 73 (65.8%) women. The overall success rate, including repeat doses, was 73.0% (81/111). There were no significant differences in treatment success between women with missed abortion and those with incomplete abortion (56/89 [62.9%] vs 18/22 [81.8%]; P=0.152). Anteverted uterine position was associated with significantly higher success rates compared with diverging position (62/86 [72.1%] vs 4/18 [22.2%]; P=0.001). CONCLUSION: Misoprostol is an effective treatment for early pregnancy failure. Uterine position might impact the success of medical treatment for missed abortion.

Gestational diabetes: women's concerns, mood state, quality of life and treatment satisfaction.

OBJECTIVE: The aim of this observational cohort study was to explore concerns, mood state, quality of life (QoL) and treatment satisfaction of women treated for gestational diabetes (GDM). METHODS: Twenty-seven diet-treated and 18 insulin-treated women participated in a semi-structured interview and completed a series of three different questionnaires. RESULTS: Qualitative analysis identified "the baby's health" as dominant concern, but also as main motivational treatment factor. Treatment satisfaction was generally high and further increased, whereas QoL and mood state significantly dropped over time. CONCLUSIONS: Acknowledgment of women's concerns and precise information may improve treatment compliance and outcome.

Management of diabetes in pregnancy: comparison of guidelines with current practice at Austrian and Australian obstetric center.

AIM: To compare Austrian and Australian national guidelines for gestational and pre-gestational diabetes and estimate the level to which physicians comply with their country's guidelines. METHODS: Austrian (ODG, Austrian Diabetes Society) and Australian guidelines (ADIPS, Australasian Diabetes in Pregnancy Society) for the treatment of gestational diabetes and pre-gestational diabetes were systematically reviewed. Current practices in two obstetric centers in Austria and Australia were assessed by interviewing key stakeholders through questionnaires assessing different components of diabetes care. For gestational diabetes, these components were screening, abnormal oral glucose tolerance test values (mmol/L), abnormal values for diagnosis, further management when abnormal values are detected, monitoring/glucose targets (mmol/L), further management and indications for insulin therapy, route and timing of delivery, and postpartum management and counseling. For pre-gestational diabetes, the components were management during the preconceptional period, glucose target values, medical surveillance, obstetric surveillance, medication used, route and timing of delivery, and postpartum management and counseling. RESULTS: More variation was found in the management of gestational than pre-gestational diabetes. There were differences in oral glucose tolerance test and cut-off levels for diagnosing gestational diabetes in both centers and guidelines. Australian guidelines recommended two-stage screening for gestational diabetes, while Austrian guidelines recommended one-stage screening. At the Austrian obstetric center, amniocentesis was recommended for determining the start of insulin treatment in pregnant women with gestational diabetes. This approach was neither used at the Australian obstetric center nor recommended by any of the two guidelines. CONCLUSION: Our study showed that it was difficult to standardize screening criteria and diagnostic methods for gestational and pre-gestational diabetes. National and international consensus has yet to be achieved in the management of diabetes in pregnancy.

Fungi: a normal content of human nasal mucus.

BACKGROUND: In recent studies, we showed that 91.3% of both CRS patients and healthy controls grew positive fungal cultures out of their nasal mucus, which therefore appears to be a common finding within the adult population. However, it still was unknown as of when fungi could be cultured from nasal mucus in human beings. We attempted to ascertain this point of time in the nasal mucus of neonates. METHODS: We examined nasal mucus from 30 neonates immediately after birth, on the 1st and 4th day postpartum and after 2 and 4 months of life. The samples obtained with sterile cotton swabs were cultured on agar plates. Fungal cultures were identified either conventionally by microscopy or with molecular techniques. To prove possible contamination during birth, mucus of the maternal birth canal was examined as well. RESULTS: In 6 of 30 (20%) of our neonates we found positive fungal cultures immediately after birth in (3 of them Candida albicans) most likely because of contamination passing the maternal birth canal. In 2 of 29 (7%) of our neonates, positive fungal cultures were obtained on the 1st day postpartum, and in 4 of 26 (15%) positive fungal cultures were obtained on the 4th day, all limited to 1 day only and without clinical symptoms of colonization. After the 2nd month of life, examination of nasal mucus yielded positive fungal cultures in 8 of 11 (72%), and after 4 months examination of nasal mucus yielded positive fungal cultures in 17 of 18 (94%) of our babies, with a wide array of different species. CONCLUSION: Fungi can be cultured from nasal mucus as soon as contact with the environmental air exists but they are not persistent in the 1st day of life. However, after 4 months, the situation is similar to the one in adults: fungal cultures can be obtained from almost everyone's nose. Therefore, fungi must be considered a normal content of nasal mucus.