What is this condition?

Dilated cardiomyopathy is caused by extensively damaged heart muscle fibers. This disorder interferes with the heart’s metabolism and greatly enlarges all four chambers of the heart, giving the heart a globular shape and causing it to contract poorly .

Dilated cardiomyopathy leads to intractable congestive heart failure, irregular heart rhythm, and emboli (blood clots or other material that is carried in the bloodstream). Because this disease usually isn’t diagnosed until it’s in the advanced stages, the prognosis is generally poor.

What causes it?

The cause of most cardiomyopathies is unknown. Dilated cardiomyopathy may occur as a primary heart disease or it may result from viruses, endocrine and electrolyte disorders, or nutritional deficiencies. Other causes include muscle disorders (myasthenia gravis, progressive muscular dystrophy, myotonic dystrophy), infiltrative disorders (hemochromatosis, amyloidosis, sarcoidosis), and some­times pregnancy.

Cardiomyopathy may also be a complication of alcoholism. The condition may improve somewhat with abstinence but recurs when the person resumes drinking.

What are its symptoms?

In dilated cardiomyopathy, the heart ejects blood less efficiently than normal. Consequently, a large volume of blood remains in the left ventricle after its contraction, causing shortness of breath, fatigue, an irritating dry cough at night, swelling, liver engorgement, and swelling of the neck veins.

How is it diagnosed?

No single test confirms dilated cardiomyopathy. Diagnosis requires elimination of other possible causes of congestive heart failure and irregular heart rhythms. Tests include the following:

• Electrocardiography and angiography rule out ischemic heart disease; the electrocardiogram may also show an enlarged heart .

• Chest X-ray demonstrates an enlarged heart, lung congestion, or pleural effusion.

How is it treated?

Therapeutic goals include correcting the underlying causes and improving the heart’s pumping ability with drugs, oxygen, and a sodium-restricted diet. Other options may include bed rest and steroids.

When these treatments fail, therapy may require a heart transplant for carefully selected people. Another option for selected individuals is cardiomyoplasty, a surgical procedure in which the latissimus dorsi muscle is wrapped around the ventricles. This helps the ventricle to effectively pump blood. A cardiomyostimulator delivers bursts of electrical impulses to contract the muscle

ShareThis

These include a group of diseases of unknown cause that lead to a degeneration or disappearance of the myelin (insulation) around nerves, with an effect similar to stripping away the rubber insulation from an electric wire.

Demyelinated nerve fibers lose the power to conduct messages or impulses from the brain to the muscles, as well as messages of touch, pain, vision and hearing to the brain. In consequence, there may be paralysis or numbness in an arm or leg, or unsteady (ataxic) gait, blindness, loss of bladder and bowel control. Although some authorities speculate that an hereditary predisposition is responsible for the demyelination of the nerves, and others attribute the illness to some abnormal chemistry in the body, the actual cause remains unknown.

Multiple sclerosis is a strange disease that attacks any part of the brain, spinal cord and nerves with spots of degeneration, and is characterized clinically by paralysis, numbness, blindness, deafness, unsteady gait (ataxia), impairment of speech and mental changes. It usually begins during the early years of life, most often between 20 and 30 years of age.

The first sign of illness may be the sudden paralysis of a leg, or half of the body, or the sudden loss of vision in one eye. This could persist and slowly progress to add other symptoms, but usually the first symptoms disappear within weeks or months, to be replaced in the course of a year or years with a succession of the same or other symptoms, in various parts of the body.

The disappearance of symptoms is referred to as a “remission” and the reappearance as a “relapse.” These remissions and relapses may spread over a period of five, ten or more years, after which there is a tendency toward steady progression of the disease, until partial or total invalidism ensues.

There is no specific treatment as yet, nor any means of prevention of the disease. However, considerable research is under way in hope of reaching better understanding of the cause and the means to combat the illness. There is a Multiple Sclerosis Foundation that may be contacted for information as to the latest developments and prospects. Any person who develops sudden paralysis, numbness, blindness, or deafness, must obtain immediate study by a neurologist.

Amyotrophic lateral sclerosis

Because this medical term is so difficult to remember, it has come to be known in popular language as “Lou Gehrig’s Disease”, after the famous ballplayer who became afflicted with it. This illness differs sharply from multiple sclerosis, in that the patches of degeneration are not as diffusely spread out through the entire nervous system, but tend to localize on bundles of motor nerves in the brain and spinal cord, causing a slowly progressive paralysis and wasting (atrophy) of muscles on both sides of the body, sometimes more on one side than on the other. The hands often manifest the first signs of wasting and weakness, and later the legs. There is never numbness or blindness here. No specific treatment is, as yet, available for this disease, just as there is none for multiple sclerosis, although injections of B-12 and other vitamins (B-6) prove of some ameliorating value.

ShareThis

What is this condition?

The dominant effect of this disease is the loss of oxygen and nutrients to the heart because of diminished blood flow through the heart’s arteries. This disease is near epidemic in the Western world.

Coronary artery disease occurs more often in men than in women, in whites, and in middle-aged and elderly people. In the past, it rarely affected premenopausal women, bur that’s no longer the case - perhaps because many women now take oral contraceptives, smoke cigarettes, and are employed in stressful jobs that used to be held exclusively by men.

What causes it?

Axherosclerosis is the usual cause of coronary artery disease. In atherosclerosis, fatty and fibrous plaques narrow the interior channel of the heart’s arteries. They reduce the volume of blood that can flow through the arteries, thereby damaging the heart. Plaque formation also predisposes a person to thrombosis (blood clot formation), which can provoke a heart attack.

Atherosclerosis usually develops in high-flow, high-pressure arteries, such as those in the heart, brain, and kidneys, and in the aorta. It has been linked to many risk factors: family history, high blood pressure, obesity, smoking, diabetes, stress, sedentary lifestyle, and high cholesterol and triglyceride levels.

Uncommon causes of reduced coronary artery blood flow include dissecting aneurysms, infectious vasculitis, syphilis, and congenital defects in the coronary vascular system. Coronary artery spasms may also impede blood flow.

What are its symptoms?

The classic symptom of coronary artery disease is angina, which results from inadequate flow of oxygen to the heart. Angina is described as a burning, squeezing, or tight feeling in the chest that may radiate to the left arm, neck, jaw, or shoulder blade. Typically, the person clenches his or her fist over the chest or rubs the left arm when describing the pain, which may be accompanied by nausea, vomiting, fainting, sweating, and cool arms and legs.

Anginal episodes most often follow physical exertion bur may also follow emotional excitement, exposure to cold, or a large meal. Severe and prolonged anginal pain generally suggests a heart attack.

How is it diagnosed?

The person’s history - including the frequency and duration of angina and the presence of associated risk factors - is crucial in evaluating coronary artery disease. Diagnostic test results include the following:

• Electrocardiogram during angina shows heart damage and, possibly, an irregular heart rhythm. It tends to be normal when the person is pain-free.
• Treadmill or bicycle stress test may provoke chest pain and signs of heart damage.
• Coronary angiography reveals coronary artery narrowing or block­age.
• Myocardial perfUsion imaging (with thallium-20l or Cardiolite) during treadmill exercise detects damaged areas of the heart, seen as “cold spots.”

How is it treated?

The goal of treatment is to either reduce the heart’s oxygen demand or increase its oxygen supply. Drug therapy consists primarily of nitrates such as nitroglycerin (given beneath the tongue, orally, through the skin in patch form, or topically in ointment form), Isordil (given beneath the tongue or orally), beta blockers (given orally), or calcium channel blockers (given orally).

Blocked coronary arteries may necessitate coronary artery bypass surgery and the use of vein grafts. In people with only partial block­age of the coronary arteries, the doctor may perform angioplasty, a procedure in which a catheter is used to compress fatty deposits and relieve blockages. Laser angioplasty, a newer procedure, corrects the blockage by melting fatty deposits.

Because coronary artery disease is so widespread, prevention is very important. Dietary restrictions aimed at reducing intake of calories (in obesity) and of salt, fats, and cholesterol serve to minimize the risk, especially when supplemented with regular exercise. Stopping smoking and reducing stress are also beneficial.

Other preventive actions include controlling high blood pressure, reducing triglyceride levels, and taking 2.5 grains of aspirin daily (to reduce the threat of blood clots).

What can a person with coronary artery disease do?

• Be sure to follow the prescribed drug therapy, exercise program, and diet.
• Get regular, moderate exercise.
• Enroll in a self-help program to stop smoking .

ShareThis

What is this condition?

A major cause of blindness worldwide, corneal ulcers produce scar­ring or perforation of the cornea. They occur in the central or marginal areas of the cornea, but marginal ulcers are the most common form. A person may have one or several ulcers, of varied size and shape. Prompt treatment (within hours of onset) can prevent visual impairment.

What causes it?

A corneal ulcer generally results from infections by protozoa, bacteria, viruses, or fungi. Other causes include trauma, exposure, vitamin A deficiency, toxins, and allergens.

What are its symptoms?

Typically, a corneal ulcer causes pain (aggravated by blinking) and sensitivity to light, followed by increased tearing. Eventually, a central corneal ulcer blurs vision markedly. Bacterial ulcers may produce a pus-filled discharge.

How is it diagnosed?

A history of trauma or use of contact lenses and a penlight exam that reveals an irregular corneal surface suggest a corneal ulcer. Fluoresce-in dye, instilled in the conjunctival sac, stains the outline of the ulcer and confirms the diagnosis. Cultures of corneal scraping may identify the causative bacterium or fungus.

How is it treated?

Treatment aims to relieve pain and eliminate the underlying cause of the ulcer, as follows:

• Pseudomonas aeruginosa: the antibiotics Aerosporin and Garamycin, given topically and by subconjunctival injection, or Geocillin and Tobrex given intravenously. Since this type of corneal ulcer spreads so rapidly, it can cause corneal perforation and loss of vision within 48 hours. Immediate treatment and isolation of hospitalized patients are required. Eye coverings are never used when treating bacterial corneal ulcers .
• herpes simplex type 1 virus: hourly topical application of Herplex or Vira-A Ophthalmic. Corneal ulcers resulting from a viral infection often recur .
• varicella-zoster virus: a topical sulfonamide ointment applied 3 to 4 times daily to prevent secondary infection. These lesions are typically painful, so the person also receives pain relievers .
• fungi: instillation of Natacyn eyedrops for Fusarium, Cephalosporoium, and Candida
• vitamin A deficiency: correction of dietary deficiency or malabsorption of vitamin A
• neurotropic ulcers or exposure keratitis: frequent instillation of artificial tears or lubricating ointments and use of a plastic bubble eye shield.

Prompt treatment is essential for all forms of corneal ulcer to prevent complications and permanent vision problems or blindness.

ShareThis

Because the brain closely fills the tight compartment of the rigid skull, any added substance inside the skull cavity, be it a hemorrhage, an infection of the brain (encephalitis), or the covers of the brain (meningitis), or increase in blood circulation, or swelling of the brain (edema) due to an allergy or brain in jury, or a new growth in the brain (brain tumor), will cause severe and constant headache until the increase in intracranial (intra-skull) pressure is relieved by spinal puncture (which removes fluid from the brain), by brain surgery, by drugs, or by the natural course of events.

Because of the important centers located in the brain and because of the fixed space inside the skull, any tumor or growth in the brain, whether benign or malignant, has to be considered malignant, since prolonged continuation of the increased intracranial pressure can produce blindness, or paralysis of one side of the body, convulsions, severe head­ache and vomiting.

It is therefore important that any sudden and persistent headache should obtain the early study and attention of a neurologist. Of course, some common sense has to be employed in such decisions, since every headache does not warrant an urgent rush to a neurologist, any more than every pimple or spot on the skin means cancer and a rush for a biopsy. When in doubt, however, it is wisest to consult a responsible authority on the subject.

Types of Brain Tumor

There are many types of brain tumor. Some are easy to reach, especially if they are located near the skull, and may be removed completely. Others are deep seated in the brain and invade large areas of its substance, so that complete removal could only be accomplished at the risk of causing further damaging symptoms, paralysis, or even death. In such situations, a small portion of the brain tumor is removed to allow for the release of the increased intracranial pressure and the temporary easing of the symptoms, with the full understanding that the unremoved parts will continue to grow and lead to paralysis, numbness, blindness, vomiting, wasting of the body and ultimate death. Deep x-ray treatment into the brain can sometimes retard the speed of growth of special types of tumor. Certain tumors such as a glioma grow very slowly and, if situated in a so-called “silent area” of the brain, may not disable the patient severely for many years. When I was 15 years of age, an older brother of a friend had a glioma removed from the cerebellum part of the brain and continued to conduct his small business. When I was 25 years of age, he had a second operation for the removal of a remnant of the same tumor, which in the course of years had grown to large size. When I was 35, he had the third operation for the same regrown tumor, following which he became totally disabled. Research is continuing in many medical centers of the country for better methods of destroying brain tumors without injury to the patient.

ShareThis

Almost every physical disorder has some connection with emotional factors. Even accidental injuries such as broken bones seem to happen more often to children with disturbed home backgrounds than to others. A psychosomatic disease, sometimes called a psychogenic disease, is one in which emotional factors are not merely present, but are dominant. This appears to be the case, for example, in many skin disorders, migraine, some types of asthma, and some gastrointestinal disorders.The term “psychosomatic” should not be used in a derogatory sense, with the suggestion that psychosomatic illnesses are imaginary. They are not. They are real physical conditions. Imaginary physical disorders that are caused entirely by mental illness are called hysteria.

You know from experience that your state of mind affects your body. For instance, your heart beats faster when you are excited or frightened, a stomachache often follows an emotional scene, fear can make you sweat, and so on. These are simple examples of the interaction of the body with the mind under stress. There are far more complex links known, such as one between chronic anxiety and duodenal ulcers, though the mechanism of the linkage is not clearly understood.

There is much to be learned about psychosomatic illnesses. It may be that emotional stress is a final factor or “last straw” in precipitating health problems in people who have some genetic susceptibility to a disease already. Significantly, a tendency to develop disorders such as asthma, eczema, irritable colon, or migraine under stress seems to run in families.

What is The Treatment?

If you develop an illness that is known to have a psychosomatic element, your physician may ask questions about your lifestyle. If straightforward medical treatment does not relieve your symptoms, he or she may begin to concentrate on helping you to handle the stresses of your day-to-day life. The knowledge that you can probably avoid or lessen certain symptoms by avoiding certain emotional strains may be helpful. For example, relaxation exercises, together with a change or two in your daily routine, can be particularly helpful in treating vascular, or circulatory, disorders such as some types of high blood pressure.

ShareThis

What is this Condition?

Peritonitis is an acute or chronic inflammation of the peritoneum, the membrane that lines the abdominal cavity and covers the abdominal organs. The inflammation may extend throughout the peritoneum or may create an abscess in one spot.

Peritonitis commonly decreases the intestine’s action and causes it to bulge with gas. The death rate is 10%. Mortality was much higher before the advent of antibiotics.

What Causes it?

In peritonitis, bacteria invade the peritoneal membrane. The bacteria typically come from the digestive tract during traumatic disorders such as appendicitis, diverticulitis, peptic ulcer, ulcerative colitis, volvulus, strangulated bowel obstruction, an abdominal tumor, or a stab wound. Peritonitis can also be a chemical inflammation. This can follow rupture of a fallopian tube, ovarian tube, or the bladder. Other possible causes include perforation of a gastric ulcer or release of pancreatic enzymes. In both types of inflammation, accumulated fluids containing proteins and electrolytes make the normally transparent peritoneum red, inflamed, and swollen.

What are its Symptoms?

The person with peritonitis feels sudden, severe, and widespread abdominal pain that tends to intensify and localize in the area of the underlying infection. For instance, if appendicitis causes the rupture, pain focuses in the lower right abdomen.

The person is often weak, pale, sweating, and has cold skin due to excessive loss of fluid, electrolytes, and protein into the abdominal cavity. Intestinal muscles stop working and the resulting obstruction causes nausea, vomiting, and abdominal rigidity.

Other symptoms include light-headedness, irregular heartbeat, signs of dehydration (thirst, dry swollen tongue, pinched skin), acutely tender abdomen, and a fever. Inflammation of the peritoneum around the diaphragm may cause shoulder pain and hiccups. Abdominal pressure can interfere with breathing. Typically, the person with peritonitis tends to breathe shallowly and move as little as possible to minimize pain.

How is it Diagnosed?

Severe abdominal pain in a person with tenderness suggests peritonitis. The doctor will use abdominal X-rays to confirm that the small and large bowels are distended. If the person has perforation of a visceral organ, the X-ray shows air in the abdominal cavity. Other tests that may provide information include chest X-ray, blood studies, paracentesis, and laparotomy.

How is it Treated?

The doctor will try to treat any digestive tract inflammations early enough to prevent peritonitis. After peritonitis develops, however, the doctor will take emergency measures to combat infection, restore intestinal activity, and replace fluids and electrolytes.

Massive antibiotic therapy usually includes administration of Mefoxin with an aminoglycoside or Bicillin L-A and Cleocin with an aminoglycoside, depending on the infecting organisms. To decrease muscle movement and prevent perforation, the person should receive nothing by mouth, but should receive supportive fluids and electrolytes intravenously.

Surgical Treatment

When peritonitis is caused by perforation, surgery is necessary as soon as the persons condition is stable enough to tolerate it. To prepare the person for surgery, the doctor will give pain relievers and use a nasal tube to relieve pressure in the bowel and, possibly, a rectal tube to help the person pass gas.

The surgeon’s job is to eliminate the source of infection by evacuating the spilled contents and inserting drains. Occasionally, a tube is used to remove accumulated fluid. Irrigation of the abdominal cavity with antibiotic solutions during surgery may be appropriate in some cases.

ShareThis

What is this Condition?

Muscular dystrophy is actually a group of inherited disorders characterized by a progressive, symmetrical wasting away of skeletal muscles that occurs without causing pain or loss of feeling in the limbs. Paradoxically, these damaged muscles tend to enlarge because of connective tissue and fat deposition, giving a false impression of muscle strength.

So far, there is no cure for the condition, but there are four main types of muscular dystrophy, each with a different outcome. Duchenne type muscular dystrophy accounts for 50% of all cases. It generally strikes during early childhood and results in death by age 20. Becker’s muscular dystrophy is slower to develop, and people with it usually live into their 40s. The two last types (dystrophy of the face, shoulders, and arms and limb-girdle dystrophy) usually don’t shorten life expectancy.

What Causes it?

Muscular dystrophy is caused by various genes. The Duchenne and Becker types are carried by sex-linked genes affecting only men. Dystrophy of the face, shoulders, and arms and limb-girdle dystrophy are not sex-linked, so affect both sexes about equally.

What are its Symptoms?

Each type of muscular dystrophy causes progressive muscle deterioration, but incidence and severity varies in the following ways:

• The Duchenne type begins subtly, between ages 3 and 5. Children with this disorder have a waddling gait and difficulty climbing stairs, fall down often, can’t run properly, and their shoulder bones flare out (or “wing”) when they raise their arms.

Usually, a child with muscular dystrophy is confined to a wheel­chair by ages 9 to 12. Finally, progressive weakening of the heart muscle leads to death from sudden heart failure, respiratory failure, or infection.

• Although similar to the Duchenne type, the symptoms of Becker’s muscular dystrophy progress more slowly. Symptoms start around age 5, but children can still walk well beyond age 15 - sometimes into their 40s.

• Dystrophy of the face, shoulders, and arms is a slowly progressive and relatively harmless type that commonly occurs before age 10 but may develop during early adolescence. In the early stages, infants may not be able to suckle; children cant pucker their mouths or whistle or raise their arms above their heads. Affected children may have abnormal facial movements and a lack of facial movements when laughing or crying .

• Limb-girdle dystrophy follows a similarly slow course and often causes only slight disability. Usually, it begins between ages 6 and 10, causing muscle weakness first in the upper arm and pelvic muscles; then, the other common symptoms appear.

How is it Diagnosed?

The doctor examines the child, asks questions of the family, and orders certain tests. If another family member has muscular dystrophy, that persons symptoms usually tell a lot about the child’s future. If no one else has the disorder, tests of nerve activity in the affected muscles can reveal muscular dystrophy, and a muscle biopsy can show cell changes or cell fat and tissue deposits.

Medical centers with the most advanced immunologic and molecular biological techniques can accurately predict muscular dystrophy in the fetus. They can also test parents and relatives who may carry the genes for Duchenne and Becker’s muscular dystrophies.

How is it Treated?

No treatment has yet been found that can stop the progressive muscle deterioration of muscular dystrophy. However, orthopedic appliances, as well as exercise, physical therapy, and surgery to correct contractures, can help preserve the child or young adult’s mobility and independence for a time.

Family members who are carriers of muscular dystrophy should receive genetic counseling regarding the risk of transmitting this disease to their children.

ShareThis

What are these Conditions?

Folliculitis is a bacterial infection of the hair follicle that causes formation of a pustule - a collection of pus beneath the outer skin layer. The infection can be superficial or deep.

Folliculitis may also lead to the development of furuncles (furunculosis), commonly known as boils, or carbuncles (carbunculosis). The prognosis depends on the severity of the infection and on the person’s physical condition and ability to resist infection.

What Causes them?

The most common cause of folliculitis, boils, or carbunculosis is a bacterium called Staphylococcus aureus. Factors that increase a person’s risk of developing these conditions include an infected wound, poor hygiene, debilitation, diabetes, cosmetics that clog pores, tight clothes, friction, exposure to chemicals, and treatment of skin lesions with tar or with occlusive therapy, using steroids. Boils often follow folliculitis that’s exacerbated by irritation, pressure, friction, or perspiration. Persistent infection and boils may lead to carbunculosis.

What are their Symptoms?

Pustules of folliculitis usually appear on the scalp, arms, and legs in children; on the face of bearded men; and on the eyelids. Deep folliculitis may be painful.

Folliculitis may progress to hard, painful boils, which commonly develop on the neck, face, underarms, and buttocks. These boils enlarge for several days and then rupture, discharging pus and necrotic material. After they rupture, pain subsides, but redness and swelling may persist for days or weeks.

Carbunculosis is marked by extremely painful, deep abscesses that drain through many openings onto the skin surface, usually around several hair follicles. Fever and malaise may accompany these lesions.

How are they Diagnosed?

The presence of characteristic skin lesions confirms folliculitis, boils, or carbunculosis. A wound culture performed in a lab reveals the infecting organism. In carbunculosis, the person’s history reveals preexistent boils. A complete blood count may show an elevated number of white blood cells.

How are they Treated?

Treatment of folliculitis consists of cleaning the infected area thoroughly with soap and water; applying warm, wet compresses to promote drainage from the lesions; topical antibiotics, such as Bactroban ointment; and in extensive infection, systemic antibiotics (E-Mycin or Dynapen). Boils may also require incision and drainage of ripe lesions after application of warm, wet compresses, and topical antibiotics after drainage. Carbunculosis is treated with systemic antibiotics.

ShareThis

What is this Condition?

Pregnancy places special demands on carbohydrate metabolism and increases the body’s insulin requirement, even in a healthy mother. Thus, she may become prediabetic, or, if she’s diabetic, runs the risk of aggravating her preexisting condition.

The prognosis of the mother and fetus is good if the mother’s blood glucose (sugar) level is well controlled and ketosis and other complications are prevented. Infant morbidity and mortality depend on recognizing and successfully controlling low blood sugar, which may develop within hours after delivery.

What Causes it?

In diabetes, glucose is inadequately used by the body, either because insulin is not synthesized by the pancreas (as in insulin-dependent diabetes) or because body tissues resist the hormonal action of endogenous insulin (as in non-insulin-dependent diabetes). During pregnancy, the fetus relies on the mother’s glucose as a primary fuel source, but pregnancy triggers protective mechanisms that have anti-insulin effects: increased hormone production (placental lactogen, estrogen, and progesterone), which counteracts the effects of insulin; degradation of insulin by the placenta; and prolonged elevation of stress hormones (cortisol, epinephrine, and glucagon), which raises blood sugar levels.

In a normal pregnancy, an increase in anti-insulin factors is met by increased insulin production to maintain normal blood sugar levels. However, prediabetic or diabetic women can’t produce enough insulin to overcome the insulin antagonist mechanisms of pregnancy, or their tissues are insulin-resistant. As insulin requirements rise toward term, a prediabetic woman may develop gestational diabetes, requiring dietary management and, possibly, administration of insulin to achieve glucose control; an insulin-dependent woman may need to increase her insulin dosage.

What are the Symptoms?

Indications for diagnostic screening for maternal diabetes during pregnancy include obesity, excessive weight gain, excessive hunger or thirst, excessive urination, recurrent monilial infections, glucose in the urine, previous delivery of a large infant, excessive amniotic fluid, maternal high blood pressure, and a family history of diabetes.

Uncontrolled diabetes in a pregnant woman can cause stillbirth, fetal anomalies, premature delivery, and birth of an infant who is large or small for gestational age. Such infants are predisposed to severe episodes of low blood sugar shortly after birth and may also develop calcium deficiency, high levels of bilirubin in the blood, and respiratory distress syndrome.

How is it Diagnosed?

The prevalence of gestational diabetes makes careful screening for high blood sugar appropriate in all pregnancies in each trimester. Abnormal blood sugar levels measured in a fasting person or after she has eaten, signs and symptoms, and the person’s history suggest diabetes in women not previously diabetic.

A 3-hour glucose tolerance test confirms diabetes when two or more values are above normal.

Procedures to assess fetal status include stress and nonstress tests, ultrasound to determine fetal age and growth, and measurement of urine hormone levels.

How is it Treated?

Treatment of both newly diagnosed and established diabetes is designed to maintain the woman’s blood sugar levels within acceptable limits through dietary management and insulin administration. Most pregnant women with overt diabetes require hospitalization at the beginning of pregnancy to assess physical status, to check for heart and kidney disease, and to regulate diabetes.

Generally, the optimal time for delivery is between 37 and 39 weeks’ gestation. An insulin-dependent diabetic woman requires hospitalization before delivery because bed rest promotes optimal circulation to the fetus and improves uterine muscle tone. In addition, hospitalization permits frequent monitoring of blood sugar levels and prompt intervention if complications develop.

Depending on fetal status and maternal history, the obstetrician may induce labor or perform a cesarean delivery. During labor and delivery, the woman with diabetes will receive a continuous intravenous infusion of dextrose with regular insulin in water. Maternal and fetal status must be monitored closely throughout labor. The woman may benefit from half her prepregnancy dosage of insulin before a cesarean delivery. Her insulin requirement will fall markedly after delivery.

ShareThis