Reproducibility of the oral glucose tolerance test in pregnancy

Article Abstract:

Pregnant women with elevated blood glucose levels (above 140 milligrams per deciliter) between the 24th and 28th week of gestation need further screening by means of a glucose tolerance test (GTT, in which a glucose solution is ingested and blood glucose measurements taken at regular intervals). However, research with other populations has shown that results of GTTs are not always reproducible. To determine the reproducibility of the 100-gram oral GTT during pregnancy (in which 100 grams of glucose is swallowed), 64 pregnant patients were tested on two different occasions separated by one to two weeks. The glucose levels for these women had reached or exceeded 135 milligrams per deciliter after an earlier 50 gram oral glucose screening test. For three days before each 100-gram test, the subjects consumed a special diet. Blood was sampled one, two, and three hours after the glucose was drunk; an abnormal result was recorded if two or more of these values were elevated. Patients were classified according to their results on the two tests as: normal-normal (group 1 with 48 women); normal-abnormal (group 2 with 11 women); abnormal-normal (group 3 with 3 women); or abnormal-abnormal (group 4 with 2 women). Test results when performed twice were therefore different for 14 women (in groups 2 and 3). Only two of the five initially abnormal GTT results were reproducible, while 48 of 59 initially normal results were reproducible. The proportion of patients with initial normal results who then tested abnormal was greater than those with initially abnormal results who then tested normal; the reasons for this are unknown. Timely diagnosis of gestational diabetes (diabetes associated with pregnancy) is essential to prevent maternal and fetal complications. Therefore, pregnant patients with abnormal one-hour oral GTT results, or elevated but normal fasting, one- or two-hour GTT results, should undergo repeat testing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Diagnosis, Glucose tolerance tests, Glucose tolerance test, Diabetes in pregnancy, Gestational diabetes, Prenatal diagnosis

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Vaginal breech delivery: a five-year prospective evaluation of a protocol using computed tomographic pelvimetry

Article Abstract:

Although cesarean section is preferred to vaginal delivery for fetuses in the breech position (buttocks down toward the cervix, rather than head down), the surgical approach is associated with increased maternal complications without equivalent improvements in the outcome for the infant. Thus, vaginal delivery, popular in the 1950s, is returning for selected breech infants. The use of computed tomographic pelvimetry (a modern X-ray approach that allows measurement of the pelvic cavity) to evaluate patients for vaginal delivery exposes the fetus to considerably less radiation than conventional X-ray pelvimetry. To evaluate birth outcomes during a five-year period at one medical center where tomographic pelvimetry was used, a prospective study of 122 pregnant women was carried out. All infants were full-term (at least 37 weeks' gestational age). Most of the mothers had adequate pelvimetry (sufficient room for the head to emerge), as determined by tomographic measurement. Results showed that 69 patients underwent vaginal delivery (group 1), while 16 had cesarean sections (group 2) after attempting labor. An additional 37 patients (group 3) did not have adequate pelvimetry, and underwent cesareans. No differences among the groups in perinatal or neonatal outcomes were found. Group 2 had a higher incidence of endomyometritis (inflammation of the uterine lining and wall) than the other groups; otherwise, maternal outcomes were equivalent in all groups. The overall rate of 81.2 percent for successful vaginal delivery of breech infants, without increases in maternal or perinatal complications, is commendably high. The use of computed tomographic pelvimetry is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Statistics, Diagnostic imaging, Breech delivery, Breech birth, Pelvimetry

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Screening for illicit drug use in a military obstetric population

Article Abstract:

To learn more concerning the rate of illicit drug use in a military population, 500 obstetric patients using the Madigan Army Medical Center were tested. This population was socioeconomically heterogeneous, made up of women who were white, African/black American, Asian, Hispanic, and Native American. Twenty percent of the women were active-duty military personnel and the remainder were dependents of such personnel. A small sample of urine provided for routine culture was removed and tested for alcohol, cocaine metabolites, cannabinoids, opiates, and amphetamines. Results from the 470 samples (30 were lost or inadequate for testing) showed that 5 tested positive, 3 for cannabinoids and 2 for opiates. One woman who tested positive had been taking prescription narcotics. The prevalence of illicit drug use in this group was 0.85 percent, a value that is lower than that published in other population studies. Universal obstetrical screening for illicit drug use in the institution where this study took place is not recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pregnant women, Drug use, Military personnel, Military wives, Military spouses

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