Prenatal diagnosis in diabetic gravidas: utility of ultrasound and maternal serum alpha-fetoprotein screening

Article Abstract:

Diabetic women are more likely to give birth to infants with malformations than are nondiabetic women, with rates as high as 40 percent for women who have poorly controlled diabetes during the pregnancy. Ultrasound, a diagnostic imaging technique that uses high-frequency sound waves, is often used to detect major malformations of the fetus during pregnancy. Testing for maternal serum alpha-fetoprotein (MSAFP) is another method of diagnosing birth defects. High levels of alpha-fetoprotein in the mother's blood generally indicate problems with the fetus. Diabetic women, however, normally have lower levels of this protein in their blood, and thus the levels considered diagnostic must be adjusted accordingly. This increases the likelihood of false-positive results, meaning that problems may be detected that do not really exist, such that further evaluation with ultrasound will usually be required. This study examined the differences in screening diabetic and nondiabetic women during pregnancy, to find the most appropriate screening procedure for diabetic women. The pregnancies of 432 diabetic women were followed. All had at least one ultrasound examination and 393 had MSAFP tests. Any major malformations in infants born were checked against the results of ultrasound and MSAFP. Results showed that 32 infants had major malformations at birth, of which 18 (56 percent) had been detected by ultrasound. None of the problems found by ultrasound were initially detected by high MSAFP levels. MSAFP results were positive for 10 of the 29 infants that had major malformations. The ability to detect actual malformations (sensitivity) was 56 percent for ultrasound and 34 percent for MSAFP. The ability to rule out false-positive results (specificity) was 99.5 percent for ultrasound and 86 percent for MSAFP. These results indicate that MSFAP is not useful in screening diabetic women because of its low sensitivity and the fact that ultrasound can find all the defects MSFAP is meant to find, and more. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Complications and side effects, Birth defects, Diabetes in pregnancy, Gestational diabetes, Alpha fetoproteins, Prenatal ultrasonography, Ultrasonics in obstetrics

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Determination of the seroprevalence of human immunodeficiency virus infection in gravidas by non-anonymous versus anonymous testing

Article Abstract:

Human immunodeficiency virus (HIV) can be transmitted from an infected mother to her fetus, and this is a great concern because HIV is associated with AIDS (acquired immunodeficiency syndrome). Identifying pregnant women who are HIV-positive (test positive for indications of HIV) is difficult when symptoms of AIDS are not yet present. HIV testing protocols are difficult to establish since testing women with known risk factors, such as intravenous (IV) drug use, sexual contact with high risk partners, and history of blood transfusion, is dependent on the willingness of mothers to identify high risk behaviors. Unfortunately, methods of eliciting accurate histories are lacking. The effectiveness of a method to elicit a thorough account of risk factors and the prevalence of HIV-positive pregnant women were evaluated. In group I, information regarding risk factors associated with the transmission of HIV was given to women who attended a prenatal clinic. HIV tests were requested by 349 (34 percent) of the patients. In group II, the presence of risk factors was determined by questioning 849 women entering a labor and delivery unit. These women had no previous HIV risk factor counseling. The women in group II had HIV testing performed anonymously. Risk factors were reported in 63 of 349 women in group I (19 percent) and in 82 of 849 women in group II (9.6 percent). Two of the patients in group I, both of whom reported risk factors, tested positive for HIV. Of the nine patients in group II who tested positive for HIV, only four reported risk factors. Counseling that focuses on risk factors of HIV transmission may facilitate the reporting of risk factors, and lead to increased HIV testing. However, limiting HIV testing to women acknowledging risk will not correctly identify all pregnant women who are HIV-positive. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Testing, Risk factors, HIV infection, HIV infections, HIV (Viruses), HIV, Communicable diseases, Disease transmission, Pregnancy, Fetal diseases, AIDS virus carriers, HIV carriers, Communicable diseases in pregnancy

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Fetal surgery for congenital diaphragmatic hernia

Article Abstract:

Prenatal fetal surgery for congenital diaphragmatic hernia may not be beneficial, according to a study of 24 pregnant women. A diaphragmatic hernia is an opening in the diaphragm that allows the abdominal organs to move into the chest. This compresses the lungs and heart, preventing them from developing normally. Most affected babies can be treated after they are born.

Care and treatment, Evaluation, Fetus, Surgery, Fetal surgery, Diaphragm, Diaphragmatic hernia

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