Diabetic retinopathy in pregnancy: a review

Article Abstract:

When diabetic women become pregnant, they face the possibility of serious damage to the retina (the part of the eye that receives primary visual information). Diabetic retinopathy (disease of the retina) is the leading cause of blindness among people aged 24 to 64, a time span that includes the fertile years. A review of diabetic retinopathy is presented. In diabetics, abnormalities in small blood vessels are thought to result from chronic hyperglycemia (high blood levels of glucose, or sugar); the retina may also be affected by environmental, genetic, or other factors. Diabetic retinopathy is present with varying severity, and its lesions are usually located in the central part of the retina. The three main stages are background diabetic retinopathy, followed by the preproliferative and proliferative stages. The main anatomical characteristics of each stage are described; in short, retinal blood vessels become increasingly abnormal, with ingrowth of new, abnormal vessels in the latter stages. Without treatment, half of all high-risk patients (identified by certain retinal changes) will be blind within five years from the onset of the disease. The effects of pregnancy on diabetic retinopathy have generally been considered to be severe; however, some reports indicate this is not always true. Moreover, many changes that occur during pregnancy are reversible. Experimental findings regarding this issue are briefly described. When diabetes is kept under good control, its effects on the retina are minimized; however, rapid changes to normalize blood glucose levels in the pregnant woman can actually harm the eye. Other eye disorders common to diabetic women of reproductive age are described. New treatment approaches, such as laser therapy, can substantially reduce the rate of progression to blindness. Women should undergo an ophthalmological examination prior to pregnancy so that necessary treatment can be instituted. Physicians need a standardized approach to the management of the ocular health of their diabetic patients, since diabetic retinopathy in pregnancy is unstable. Frequent examinations are imperative. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Prevention, Medical examination, Diabetics, Diabetes, Diabetes mellitus, Diabetic retinopathy, Pregnancy, Complications of, Pregnancy complications

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Cocaine abuse is associated with abruptio placentae and decreased birth weight, but not shorter labor

Article Abstract:

The use of cocaine during pregnancy has increased because of the availability of ''crack,'' a smokable form of cocaine. The incidence of cocaine use in pregnancy was shown to be 8 to 10 percent. A recent study involving the measurement of cocaine in the stools of 567 newborns showed that 20 percent tested positive for cocaine. However, only 27 percent of mothers who tested positive admitted they abused drugs, which involved cocaine, marijuana, and heroin. Urine testing was shown to be only 32 percent sensitive as compared with analysis of hair from the mother. The combination of urine testing and history-taking was found to be more reliable than analysis of maternal hair by an immunological technique known as radioimmunoassay (RIA). Cocaine use during pregnancy has been associated with abruptio placentae (the early detachment of the normally situated placenta after the 20th week of pregnancy), premature delivery, and low birth weight. Some patients admit that they take cocaine to shorten the duration of labor, an effect that has been reported in the lay press. The relation between duration of labor and cocaine use has not been studied. Hence, the relation between cocaine use in pregnancy and the incidence of abruptio placentae, birth weight, gestational age, and duration of labor was assessed in 592 women who abused cocaine during pregnancy. The results showed that women who abused cocaine during pregnancy had infants with lower birth weights who were born at an earlier gestational age than infants of mothers who did not abuse drugs. In addition, the incidence of abruptio placentae was doubled among cocaine-abusing women compared with nonabusers. The duration of labor was similar in both groups. Thus, cocaine abuse during pregnancy is associated with poor neonatal outcome and complications but not shortened labor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Birth weight, Low, Low birth weight, Cocaine abuse, Drug abuse in pregnancy, Abruptio placentae, Placental abruption

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Conservative management of second-trimester post-amniocentesis fluid leakage

Article Abstract:

Amniocentesis is a procedure performed during the second three months of pregnancy that removes fluid surrounding the fetus containing fetal cells, which are then analyzed for genetic abnormalities. Although there are few complications related to the procedure, some patients will experience vaginal bleeding or leakage of amniotic fluid after amniocentesis. Rupture of the membranes surrounding the fetus before 28 weeks of pregnancy (premature rupture of membranes, PROM) is associated with a extremely poor fetal outcome. The incidence of amniotic fluid leakage was studied after 603 amniocenteses. The seven women (1.2) who leaked fluid within 24 hours of amniocentesis were managed with strict bed rest and close monitoring. The fluid stopped leaking and the total fluid volume returned to normal within one week. Six weeks after the procedure, one patient who leaked fluid lost the fetus at 25 weeks of pregnancy. The remaining six patients completed the pregnancy without complications. Although the study sample was small, amniocentesis-related fluid leakage can be controlled. It is suggested that PROM experienced after amniocentesis is clinically different than membranes that rupture spontaneously. Although amniocentesis is relatively safe, complications requiring attention still exist. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Premature rupture of membranes, Premature rupture of the membrane, Amniocentesis, Amniotic fluid

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