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[Obstetric monitoring of the pregnant diabetic]
1Policlinico S. Orsola-Malpighi, Università degli Studi di Bologna.
In the diabetic pregnant woman, together with monitoring of carbohydrate metabolism, it is of vital importance the fetal monitoring which includes: the dating of onset of pregnancy, the diagnosis of malformation, the evaluation of fetal health. The dating of onset of pregnancy can be calculated fairly precisely measuring echographically the vertex-sacrum length and the biparietal diameter carried out respectively in the first 12 and 20 weeks of amenorrhoea. The diagnosis of malformation can be effected by traditional echography or by transvaginal echography, a new method which allows an early diagnosis of serious malformation in high risk patients. Fetal health can be evaluated by the oxytocin test, non-stress test, biophysical profile and Doppler velocimeter. All these techniques have advantages and disadvantages, of which the most misleading is the high frequency of false positives (low specificity). In the diabetic pregnant woman, to foresee fetal maturity, it is advisable to utilize a more elevated lecithin-sphingomyelin ratio (over 3-3.5) than to non-diabetic pregnant women because of less precision of this test when diabetes is present. The dosage of phosphatidyl-glycerol in the amniotic fluid may also be useful. Echography evaluation of the fetal weight is reliable above all for low or normal weight while it is less so for fetuses of high weight. The ratio between cranium and abdomen circumferences is still considered one of the best indexes to foresee macrosomia.
In the diabetic pregnant woman, together with monitoring of carbohydrate metabolism, it is of vital importance the fetal monitoring which includes: the dating of onset of pregnancy, the diagnosis of malformation, the evaluation of fetal health. The dating of onset of pregnancy can be calculated fairly precisely measuring echographically the vertex-sacrum length and the biparietal diameter carried out respectively in the first 12 and 20 weeks of amenorrhoea. The diagnosis of malformation can be effected by traditional echography or by transvaginal echography, a new method which allows an early diagnosis of serious malformation in high risk patients. Fetal health can be evaluated by the oxytocin test, non-stress test, biophysical profile and Doppler velocimeter. All these techniques have advantages and disadvantages, of which the most misleading is the high frequency of false positives (low specificity). In the diabetic pregnant woman, to foresee fetal maturity, it is advisable to utilize a more elevated lecithin-sphingomyelin ratio (over 3-3.5) than to non-diabetic pregnant women because of less precision of this test when diabetes is present. The dosage of phosphatidyl-glycerol in the amniotic fluid may also be useful. Echography evaluation of the fetal weight is reliable above all for low or normal weight while it is less so for fetuses of high weight. The ratio between cranium and abdomen circumferences is still considered one of the best indexes to foresee macrosomia.