[Pregnancy in diabetic women. Apropos of 9 pregnancies. Management]

Pregnancy in a diabetic woman carries with it a risk of intra-uterine death for the foetus. In this paper the authors report on 9 cases of pregnancy in diabetic women and the results obtained when a systematic management of the condition involving delivery before term, always by caesarean section, is carried out. It is absolutely vital to have perfect stabilisation of the diabetic state during the pregnancy, in order to do this the patient must be seen very often and brought into hospital early, soon after the 28th week. It would appear to us that caesarean delivery is the delivery of choice because it allows the extraction of a foetus in good condition, at a chosen time when a trained team is ready. It is essential to end the pregnancy somewhere between the 36th and 37th week of the pregnancy and sometimes even earlier if there is associated pathology such as toxaemia. This systematic method implies a constant check on the fetal well-being by oestriol estimations, although we realise that the levels are still low between the 7th and 8th month and that watching a graph that is steadily climbing allows the team to wait until the calculated date for bringing the pregnancy to its conclusion. In two cases the pregnancy was interrupted early because of variations in the graph; in one early delivery was justified by the development of toxaemia and in the other a moderate drop in the oestriol levels led us to intervene early. When there is a drop in the levels is it very important to ensure that is is due to fetal distress and not to daily physiological changes because the risk is of excessive prematurity if induction is carried out too soon.