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AIM: To determine the incidence of different complications of the apparently healthy full-term infants of diabetic mothers (IDMs) and whether these complications could be predicted early. METHODS: A prospective study was performed in the Nursery Unit of King Fahd Hospital of the University in Al-Khobar over an 18-month period. Eligible neonates were those full-term IDMs who were asymptomatic at birth, with birth weight ≥ 2000 g and whose mothers had gestational or pregestational diabetes. AUDMs were routinely observed for at least 2 days. A complete blood count, glucose, bilirubin and calcium serum levels were monitored. The morbidity study group included all IDMs who experienced complications requiring treatment or observation for > 48 hours. RESULTS: One hundred and eighty eight infants with a birth-weight of 3411 ± 616 g and with gestational age of 38.5 ± 1.2 weeks were enrolled in the study. Asymptomatic hypoglycemia (31%) was mostly mild and transient. The rate of other complications such as hypocalcemia (4%), polycythemia (13%), hyperbilirubinemia (18%), intrauterine growth retardation (2%) with 30% rate for large gestational age. Using a logistic regression model; maternal insulin therapy, poor diabetic control, birth asphyxia, early neonatal hypoglycemia and polycythemia were found to be highly predictive of morbidity with an odd ratio of 2.41, 2.91, 9.65, 3.88 and 3.74 respectively. CONCLUSION: Complications of apparently healthy IDMs appear to be very mild and transient. These were found to be strongly associated with specific perinatal events.

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OBJECTIVE: The aim of the study is to identify the major causes of perinatal mortality and to determine the main maternal factors which affect perinatal mortality at the King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. METHODS: A retrospective study was conducted covering a period of ten years from January 1987 to December 1996. All 548 perinatal deaths, which occurred during that period, were analyzed according to Wigglesworth classification. RESULTS: The study revealed a perinatal mortality rate of 19.2:1,000 births. Lethal malformations accounted for 116 (21.1%) of fetal deaths. Of the remaining 432 deaths, 214 (49.5%) occurred antenatally, 71 (16.5%) in labour and 147 (34%) within the first week of delivery. Amongst the normally formed babies, low birth weight was the commonest cause of death (29%) followed by the consequences of maternal diseases (14.8%). The cause of death was unknown in 17.3% of mature babies who died. Unbooked patients were responsible for 72% of the total perinatal deaths. CONCLUSION: Reduction of the perinatal mortality rate is possible when all women begin to value preconception counselling and attendance at antenatal clinics.

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The purpose of the study was to determine the incidence of congenital anomalies among infants of diabetic mothers and compare this with the normal obstetric population in our hospital. Among 17 463 patients delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia between January 1987 and December 1992 there were 466 diabetic mothers who delivered 466 singleton births. The incidence of diabetes was 2.6%. Among those 466 diabetic patients there were 132 with clinical diabetes which was present before pregnancy and which required insulin treatment during pregnancy and 334 with gestational diabetes. There were 14 lethal congenital anomalies among the infants of diabetic mothers (3%) compared with 69 anomalies in general obstetric population (0.4%). The difference = was very highly significant P = 0.001. Ten anomalies were responsible for 10 stillbirths and the other four anomalies resulted in four neonatal deaths. The most common anomalies were those of the central nervous system and multiple fetal anomalies, followed by cardiovascular system, renal and chromosomal anomalies. All those anomalies occurred in the infants whose mothers had clinical diabetes.

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OBJECTIVE: The purpose of the study was to determine whether the use of prophylactic oral ritodrine or hospitalization for bed rest can prolong pregnancy in multiple pregnancy. METHODS: The study was conducted over a period of 8 years and included 189 cases of multiple pregnancy, all of which were delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, between July 1986 and August 1994. The patients were divided into three groups: the first group included 64 patients who received oral ritodrine from the 25th to the end of the 37th week of gestation; the second group included 57 patients who were hospitalized from the 28th to the 32nd week of gestation; and the third group, considered the control group, included 68 patients who were managed on an outpatient basis only. Forty-six cases of multiple pregnancy were excluded from the study for a variety of reasons. RESULTS: The study showed an increase in gestational age at delivery, an increase in mean birth weight and a reduction in preterm delivery in the group treated with prophylactic ritodrine (P = 0.03). In the hospitalized group there was no effect on duration of gestation or reduction in preterm delivery, but there was an increase in mean birth weight (P = 0.04). Several patients experienced troublesome side effects with ritodrine. CONCLUSION: Our study indicates that the prophylactic use of beta-sympathomimetics is more effective, beneficial and less expensive than hospitalization for bed rest in prevention of preterm labor and delivery in multiple pregnancy.

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OBJECTIVE: The purpose of the study was to determine the best regimen for metabolic control of gestational diabetes. METHODS: A prospective study was conducted over a period of 5 years in 355 diabetic women delivered at the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, between January 1987 and December 1991. The patients were divided into three groups according to their mean plasma glucose levels during pregnancy: good control was defined as a mean plasma glucose level of less than 120 mg/dl (group A); moderate control as a mean plasma glucose level between 120 and 140 mg/dl (group B); and poor control as a mean plasma glucose level in excess of 140 mg/dl (group C). The t-test was used for statistical analysis. RESULTS: Antenatal and neonatal complications were much higher in groups B and C than in group A, the overall complication rate being five times higher in group C than in group A. CONCLUSION: The data indicate that good glycemic control is one determinant of maternal and fetal complications in pregnancies complicated by gestational diabetes.

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A retrospective, case-control study was performed to determine risk factors associated with wound infection after cesarean section. There were 95 wound infections among 1,442 cesarean sections performed denoting a wound infection rate of 6.6%. The records of these 95 patients and 95 controls were studied. The following variables were significantly associated with wound infection: length of labor, rupture of membranes and delivery interval, number of vaginal examinations performed preoperatively, presence of chorioamnionitis, operating time, estimated blood loss during surgery, and obesity. Elective surgery resulted in a lower incidence (2.4%) of wound infection than emergency surgery (4.2%). The mean hospital stay was 5 days longer in patients with wound infection. Wound dehiscence requiring resuture occurred in 4.2% of patients.

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A retrospective analysis of 17,127 singleton vaginal deliveries revealed 56 cases of shoulder dystocia giving an incidence of 0.3%. Although an increasing incidence of shoulder dystocia was noted as the infant birth-weight increased, 41% of shoulder dystocia occurred in infants of average birth-weight (2,500-3,999g). Diabetes mellitus, postmaturity, maternal weight above 90 kg were each factors associated with a large sized infant which should signal the possible occurrence of shoulder dystocia. In the present series shoulder dystocia occurred in 2.7% of all infants weighing 4,000 g or more. Diabetic women experienced shoulder dystocia more often than non-diabetics. In the diabetics 15.7% of neonates of birth-weight 4,000 g and above sustained shoulder dystocia compared to 1.6% in the nondiabetic patients. Immediate neonatal injury was apparent in 43% of infants with shoulder dystocia, Erb palsy being the commonest injury. The perinatal mortality rate in the series was 54/1,000 deliveries. There was no maternal death. To avoid the potentially lethal and dangerous complications of shoulder dystocia, all clinical and technological methods available should be utilized to detect the excessive sized infants so that abdominal delivery may be performed before it is too late.

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