J Reprod Med
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Ketoacidosis remains one of the most serious complications that can occur in the pregnant diabetic. A 36-year-old class D diabetic presented at 35 weeks' gestation with signs and symptoms of diabetic ketoacidosis. ⋯ The development of ketoacidosis is a well-known complication of insulin administered via pregnancy. We recommend that the insulin pump be used in selected patients in whom close surveillance can be maintained.
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The obstetric and anesthetic considerations in the management of a patient with the May-Hegglin anomaly, an autosomal dominant platelet deficiency, are discussed. A review of the medical literature notes three previous case reports of May-Hegglin anomaly in pregnancy. ⋯ Anesthetic managements included general and spinal anesthesia: the latter employed following platelet transfusion. A successful pregnancy should be anticipated when management includes a well-informed patient and coordinated obstetric and anesthetic care.
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We investigated the motivation behind procedures in 241 patients with prior cesarean births; 120 had elective repeat cesarean sections and 121 had vaginal birth after cesarean section (VBAC). Patients were of similar age, gravity and parity, but significantly more patients in the repeat cesarean group had their initial surgery because of failure to progress in labor; significantly more patients in the VBAC group had their initial cesarean section because of fetal distress. ⋯ The main factors behind the decision to have repeat cesarean sections were medical or obstetric indication (45.8%), patient's desire (31.6%), patient's desire and physician's advice (9.1%) and physician's advice (13.3%). We conclude that it will be difficult to substantially decrease the present rate of repeat cesarean births, and that preventive efforts should be directed toward decreasing the incidence of primary cesarean deliveries.