DIABETES IN
PREGNANCY - FETAL MONITORING
GESTATIONAL DIABETES
Obstet Gynecol. 1988 Dec;72(6):841-6.
Biophysical profile scoring in the management of the
diabetic pregnancy.
Johnson JM, Lange IR, Harman CR, Torchia MG, Manning
FA.
Department of Obstetrics, Gynecology, and
Reproductive Sciences, University of Manitoba,
Winnipeg, Canada.
Biophysical profile scoring was the principal
technique of antepartum fetal surveillance in 238
well-controlled diabetic pregnancies. Fifty
insulin-dependent diabetics had twice-weekly
testing, and 188 gestational diabetics had weekly
testing. Intervention was not pursued unless there
were maternal or fetal complications. There were no
stillbirths and three neonatal deaths, all resulting
from congenital anomalies, giving a corrected
perinatal mortality rate of 0. The incidence of
abnormal biophysical profile scores, eight of 238
(3.3%) overall, was low, with no significant
difference between types of diabetics. In those with
an abnormal score, intervention was mandated; the
cesarean section rate was 50% and the rate of
intensive care nursery admissions was high. Of the
230 fetuses with a normal biophysical profile score,
200 (87%) were delivered at term with minimal
maternal or neonatal morbidity. Amniocentesis for
phospholipid profile was performed in only 33 cases
(13.9%). Hyaline membrane disease was confined to
five premature neonates (incidence 2.1%). We
conclude that antepartum fetal surveillance using
the biophysical profile score permits safe expectant
management in the diabetic pregnancy, yielding
significant clinical advantages to both mother and
fetus.
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