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Abstract
The number of pregnant women who have type 2 diabetes and the number found to have gestational diabetes are progressively increasing. In the future, as many as 20% of pregnant women may be diagnosed with diabetes. Although there is consensus regarding many issues in the treatment of pregnant women with diabetes, there are few evidenced-based studies upon which to base the timing of delivery. There must be a balance between increased neonatal morbidity of late preterm and early-term delivery and fetal mortality. Potential adverse outcomes associated with late preterm and early-term delivery include respiratory problems as well as other metabolic dysfunctions characteristic of the preterm infant of a mother with diabetes. Delivery at term increases the risk of fetal demise, fetal overgrowth, and birth injury. Even among diabetic women who practice good glycemic control, the risk of intrauterine fetal demise in third trimester appears greater than that of neonatal death. Additional prospective data are urgently needed to better understand the short and long-term risks and benefits of the timing of delivery in this very common obstetrical dilemma.
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Affiliation(s)
- Patrick M Catalano
- Department of Reproductive Biology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH 44109, USA.
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2
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Kalra B, Kalra S, Chhabra B. Posthumous Caesarean section in women with type 1 diabetes mellitus: two cases at one hospital in Northern India. Diabetologia 2010; 53:2452-3. [PMID: 20725714 DOI: 10.1007/s00125-010-1880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 07/26/2010] [Indexed: 11/30/2022]
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3
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Neckell A, Munteanu M. [Diabetus mellitus and pregnancy]. Oftalmologia 2009; 53:118-122. [PMID: 19899558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The evaluation of diabetic retinopathy during pregnancy. MATERIAL AND METHODS Retrospective study regarding 16 pregnant patients, with type 1 diabetes mellitus and variable retinal changes before the pregnancy: without retinal changes (5 cases), minimal diabetic retinopathy (7 cases), severe diabetic retinopathy (3 cases), proliferative diabetic retinopathy with panphotocoagulation before the pregnancy (1 case). The patients had a complete general and ocular investigation. RESULTS The patients without retinal changes were not influenced by pregnancy; the patients with minimal changes presented an aggravation of the diabetic retinopathy with an amelioration post-partum in 3 from the 7 cases; the patients with severe diabetic retinopathy suffered an aggravation in 1 from the 3 cases; the patients with proliferative diabetic retinopathy with panphotocoagulation before the pregnancy did not present any important changes during pregnancy. CONCLUSIONS The pregnancy represents a risk factor in the evolution of retinal changes in diabetic patients. The monitoring of the retinal changes and of the patients during the pregnancy is strongly recommended.
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4
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Abstract
AIMS To report the management and outcomes of sight-threatening diabetic retinopathy in pregnancy. METHODS A retrospective review of 8 diabetic females who developed pregnancy related sight-threatening diabetic retinopathy requiring treatment over a 12-year period. RESULTS In total, 16 eyes of eight patients were included in this series. The mean age of the patients at presentation was 30.75 years +/-3.8 SD and the mean duration of diabetes was 21.0 years +/-5.1 SD. The mean follow-up period was 46.75 months +/-47.2 SD. A total of 87.5% of patients showed progression of diabetic retinopathy during pregnancy, 71% of which were in the sight-threatening proliferative category. In the postpartum period, 81% of patients continued to progress to proliferative diabetic retinopathy, requiring panretinal photocoagulation and multiple other surgical procedures. In all, 69% of eyes retained visual acuity equal to or better than 0.3 logMAR units (6/12). CONCLUSION Sight-threatening diabetic retinopathy in pregnancy is a rare disease, but it can have devastating consequences for mother and child. Laser photocoagulation should be considered for pregnant women with severe preproliferative diabetic retinopathy. Proliferative diabetic retinopathy may not regress postpartum. Close followup should be extended in the postpartum period in this group of patients until the retinopathy is stabilised. The presence of combined rhegmatogenous and tractional retinal detachment and neovascular glaucoma were associated with the worst outcome.
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Affiliation(s)
- W C Chan
- Eye & Ear Clinic, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
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Affiliation(s)
- Elisabet Agardh
- Department of Ophthalmology, University Hospital MAS, Malmö, Sweden.
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6
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Abstract
The macrosomic fetus of a diabetic woman faces increased risk for injury at the time of birth. Cesarean section offers the potential for avoiding trauma to the fetus, but can result in increased morbidity in the mother as compared to vaginal delivery. In this article, the advantages and disadvantages of the 2 routes of delivery for the overgrown fetus of a diabetic mother are discussed. In addition, methods for diagnosing macrosomia by ultrasound are examined, along with the benefits and pitfalls of ultrasonic fetal weight estimation in the setting of diabetes. Finally, management approaches for selecting route of delivery for the macrosomic fetus are described and analyzed.
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Affiliation(s)
- Deborah L Conway
- Department of Obstetrics & Gynecology, University of Texas Health Science Center at San Antonio, 78229, USA
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Hunter SK. Present and future perspectives on the use of free or encapsulated pancreatic islet cell transplantation as a treatment of pregnancy complicated by type 1 diabetes. J Matern Fetal Med 2000; 9:46-51. [PMID: 10757435 DOI: 10.1002/(sici)1520-6661(200001/02)9:1<46::aid-mfm10>3.0.co;2-h] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pregnancies complicated by insulin-dependent diabetes mellitus (IDDM) pose significant health risks to both the mother and her developing fetus. Congenital malformations in the offspring of diabetic mothers have an incidence which is 2-5 times that seen in the background. Euglycemia in the first trimester of pregnancy can reduce this incidence, but achieving euglycemia with conventional exogenous insulin therapy is both costly and difficult. Even with intense insulin dosage adjustments, the blood glucose profile of the diabetic pregnant patient does not mimic that seen in nondiabetic patients. Both the difficulties and inadequacies of conventional therapy for IDDM-complicated pregnancy provide a stimulus for research to develop improved therapeutic modalities. Islet transplantation holds great promise as a treatment for pregnancies complicated by IDDM. This article reviews the current status of islet transplantation including the use of immunomodulation and immunoisolation techniques and their potential use for the treatment of IDDM pregnancies.
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Affiliation(s)
- S K Hunter
- Department of Obstetrics and Gynecology, University of Iowa College of Medicine, Iowa City 52242, USA.
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Hunter SK, Wang Y, Weiner CP, Niebyl J. Encapsulated beta-islet cells as a bioartificial pancreas to treat insulin-dependent diabetes during pregnancy. Am J Obstet Gynecol 1997; 177:746-52. [PMID: 9369813 DOI: 10.1016/s0002-9378(97)70262-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Our purpose was to determine the effectiveness of the bioartificial pancreas technique in correcting (1) maternal carbohydrate metabolism and (2) fetal malformation rates in a pregnant diabetic animal model. STUDY DESIGN Insulin secretion from encapsulated rat islets cultured in the presence of homologous rat prolactin was determined and compared with that of controls. Streptozotocin-induced diabetic Balb/c mice were then transplanted with rat islet cells encapsulated within alginate microbeads and were then bred. Blood glucose determinations were made after transplantation and throughout gestation. Pups were delivered by cesarean section on day 19 of gestation. Outcome parameters from the transplanted study animals were compared with those of nondiabetic controls and untreated diabetic animals. RESULTS Insulin secretion was increased twofold in encapsulated rat islets exposed to prolactin compared with control values. Throughout gestation maternal weights and blood, glucose levels of transplanted animals were similar to those of nondiabetic controls. A fetal malformation rate of only 1.4% was observed in the pups from transplanted animals. CONCLUSIONS Transplanted encapsulated islets are capable of normalizing maternal carbohydrate metabolism in a pregnant diabetic animal model. This therapy, if instituted before conception, also appears to eliminate the increase in fetal malformations seen in diabetic pregnancies.
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Affiliation(s)
- S K Hunter
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA
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Barrou B, Baldi A, Bitker MO, Squifflet JP, Gruessner RW, Sutherland DE. Pregnancy after pancreas transplantation: report of four new cases and review of the literature. Transplant Proc 1995; 27:3043-4. [PMID: 8539835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- B Barrou
- Department of Urology, University Hospital La Pitié, Paris, France
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10
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Paternoster DM, Guerriero A, Paggioro A, Lorenzoni L, Laureti E. [Diabetic nephropathy and pregnancy]. Minerva Ginecol 1995; 47:393-9. [PMID: 8545041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Diabetes mellitus (or type 1) is a long-lasting disease (even twenty years or more) which causes kidney disease and, in the event of pregnancy, it can make differential diagnostic difficult even fort the most expert clinician. Metabolic changes caused by this type of diabetes (e.g., hypoglycemia, hyperglycemia, ketoacidosis) and their difficult compensation can often lead to the onset of eclampsia or convulsion. The diagnostic suspicion of diabetes is supported by the finding of proteinuria, edema and hypertension that are strictly correlated with the evolution of diabetic disease and sometimes exist prior to pregnancy. This cas report focuses on the diagnostic importance of clotting tests, especially in clarifying diagnostic doubts.
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Affiliation(s)
- D M Paternoster
- Istituto di Ginecologia e Ostetrica G. B. Revoltella, Università degli Studi di Padova
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11
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Aerts L, Van Assche FA. Islet transplantation in diabetic pregnant rats normalizes glucose homeostasis in their offspring. J Dev Physiol 1992; 17:283-7. [PMID: 1289391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diabetes of the mother during pregnancy induces alterations in the fetus, resulting in impaired glucose homeostasis in the offspring. In youngsters of severely diabetic mothers, during glucose infusion, hyperinsulinemia is associated with hyperresponsiveness of the beta-cells and insulin resistance. In order to normalize maternal metabolism, isolated islets from neonatal rats were transplanted into the vena porta of severely hyperglycemic (Streptozotocin) rats at day 15 of gestation. Strict glycemic control of the mothers was achieved throughout further gestation and lactation. In the adult offspring of these transplanted rats insulin levels during glucose infusion were significantly lower than in the offspring of sham-transplanted diabetic mothers and were not different from controls. The work confirms that the diabetic state of the mother during late gestation (the period of development of the endocrine pancreas and of the insulin-receptor system) is the inducing factor for the abnormal glucose homeostasis in the offspring, and normalisation of the hyperglycemia eliminates these long-term consequences.
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Affiliation(s)
- L Aerts
- Laboratory of Obstetrics & Gynaecology, U.Z. Gasthuisberg, Leuven, Belgium
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Zhang CF, Zhu XH, Dong FT, Ye JJ, Fei PF, Zhang QN, Du H. A clinical study on diabetic retinopathy. Chin Med J (Engl) 1992; 105:234-6. [PMID: 1395843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A clinical research on the diabetic retinopathy(DR) is reported. In the 662 cases of diabetes mellitus examined, the prevalence of DR was 51.3%, of which 7.6% were preproliferative and 7% proliferative. The study showed that when the disease progressed to the preproliferative and proliferative DR, laser photocoagulation could be the best treatment of choice, and panretinal photocoagulation was also quite effective in the treatment of pregnant patients with proliferative diabetic retinopathy.
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Affiliation(s)
- C F Zhang
- Department of Ophthalmology and Eye Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing
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Besnard V, Goldfarb G, Jolis P. [Anesthesia for cesarean section in the diabetic patient]. Cah Anesthesiol 1990; 38:425-30. [PMID: 2073624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- V Besnard
- Département d'Anesthésie-Réanimation chirurgicale, Hôpital Beaujon, Faculté de Médecine Xavier-Bichat, Clichy
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14
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Zhang CF. [Clinical study on preproliferative and proliferative diabetic retinopathy]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 1989; 11:242-5. [PMID: 2532967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A long-term follow-up study was carried out on 159 cases (245 eyes) of pre-proliferative and proliferative diabetic retinopathy. In 75 percent of the series, diabetic retinopathy progressed and visual acuity markedly decreased. Argon Iaser panretinal photocoagulation was performed and followed-up in 80 of the cases (138 eyes). 50.72% of these obtained good results, visual acuity improved by more than 2 lines. Only 10.14% of the treated series showed progression of the disorder. There were 10 cases of diabetic mellitus associated with pregnancy. Argon laser panretinal photocoagulation just prior to and after delivery was effective against preproliferative and proliferative diabetic retinopathy. The prognosis of pregnant patients was greatly enhanced.
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Korec R. [Pregnancy and the offspring of diabetic rats and mice before and after treatment with transplantation of insulin-producing grafts]. Cesk Gynekol 1988; 53:262-6. [PMID: 3139305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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16
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Hervet E. [Toward the disappearance of therapeutic abortions]. Bull Acad Natl Med 1985; 169:587-95. [PMID: 3904931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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17
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Hirata Y. [diabetic types and surgery]. Masui 1984; 33:1174-9. [PMID: 6520917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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18
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Abstract
The records of 23 insulin-dependent diabetics who had serial ophthalmological examinations during pregnancy and afterwards were reviewed. Fourteen pregnancies occurred in 10 patients with no retinopathy; 30% of these patients had obstetric complications. The mean birthweight was 3.5 kg. Ophthalmological status was unchanged in this group. In eight patients with background retinopathy during 10 pregnancies the obstetric complication rate was 70% and mean birthweight 3.3 kg. During pregnancy there was no evidence of progression of retinopathy. One patient developed proliferative retinopathy 4 years later. Five patients had proliferative retinopathy. The mean age (32 years) and duration of diabetes at index pregnancy (18 years) was greater than for the other groups. All patients developed pre-eclampsia and mean birthweight was 2.8 kg. Four of these patients required argon laser photocoagulation in association with pregnancy for progressive retinopathy; one died subsequently from end-stage diabetic nephropathy; the other four have maintained their pre-pregnancy visual acuity from 4 to 10 years.
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Gagliardi MA, Corbascio G, Treves S. [Current orientations of treatment in pregnancy and labor assistance in the diabetic patient]. Minerva Ginecol 1983; 35:711-4. [PMID: 6669307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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20
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Ohrt DW. The assessment of fetal lung maturity with phospholipid profiles: the importance of phosphatidylglycerol. S D J Med 1983; 36:13-7. [PMID: 6574599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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21
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Cao ZX. [Some aspects of the indications for cesarean section: report of 862 cases]. Zhonghua Fu Chan Ke Za Zhi 1983; 18:17-20, 60. [PMID: 6851759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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22
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Poliakova GP. [State of newborn infants delivered by cesarean section to women with diabetes mellitus]. Akush Ginekol (Mosk) 1980:48-50. [PMID: 7457776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Hercules BL, Wozencroft M, Gayed II, Jeacock J. Peripheral retinal ablation in the treatment of proliferative diabetic retinopathy during pregnancy. Br J Ophthalmol 1980; 64:87-93. [PMID: 6153905 PMCID: PMC1039355 DOI: 10.1136/bjo.64.2.87] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The course of proliferative diabetic retinopathy involving the optic disc was followed, and the response to peripheral retinal photocoagulation monitored by argon laser in 11 patients during and after 13 pregnancies. Traditional obstetric practice assumes that pregnancy is a stimulus to irreversible progression of proliferative diabetic retinopathy, and that timely abortion and sterilisation are essential in order to achieve control of the neovascular process. Extensive photocoagulation will cause significant regression of neovascular complexes in 63% of cases, and it confers sufficient benefits to make ophthalmic indications for therapeutic abortion and sterilisation no longer tenable.
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Plotho B, Podesser H. [Cesarean section. 5-year study of results at a medium size department for obstetrics and gynecology]. Fortschr Med 1975; 93:1533-6. [PMID: 1238333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A report about the results of caesarean section from 1970-1974 is given. The rate of caesarean section was 4,2%. The list of indication is divided into vital indication, preventive indication before onset, at onset and in the first stage of labor. The morbidity was 5%, mortality 11%. The perinatal mortality was 4,4%. It is emphasized that caesarean section is still the most dangerous method of delivery.
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Van Praagh IG, Tovell HM. Primary Cesarean section in the multipara. Obstet Gynecol 1968; 32:813-25. [PMID: 5742495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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27
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Naganuma K. [Choice of anesthetics during cesarean section with complications]. Sanfujinka No Jissai 1967; 16:1102-8. [PMID: 5631808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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