PREGNANCY COMPLICATED BY DIABETES-MELLITUS IN PRIVATE-PRACTICE - REVIEW OF 10 YEARS

Two hundred private diabetic patients delivered of their infants (202) in a private hospital were evaluated for a 10 year study period (1968 to 1977). There were no maternal deaths. An 88% overall survival rate of viable infants compared favorably with that of other reported series. Analysis of each of the 10 years demonstrated marked changes in management and consequent changes in fetal survival, morbidity, and mortality rates. No neonatal deaths occurred during the last 3 years of the study period and the mortality rate in viable infants was 6.8%. There has been no significant temporal change in the incidence of toxemia or hydramnios. Fifteen stillbirths and ten neonatal deaths were analyzed to identify significant factors or parameters. Attention is directed to sex ratios (male:female) of 3:1 for stillbirths and 3:2 for infants affected with respiratory distress syndrome. Conservative use of accessory testing and antepartum hospitalization was obvious. The question of the necessity for expensive and intensive regimented institutional management is addressed. A minimum management regimen is proposed to be used in conjunction with the private obstetrician's clinical judgment and expertise. © 1979.