Insulin therapy and its consequences for the mother, foetus, and newborn in gestational diabetes mellitus.

Gestational diabetes mellitus (GDM) is a disease characterised by glucose intolerance and first diagnosed in pregnancy. This condition relates to an anomalous placental environment and aberrant placental vascular function. GDM-associated hyperglycaemia changes the placenta structure leading to abnormal development and functionality of this vital organ.

Maternal insulin therapy does not restore foetoplacental endothelial dysfunction in gestational diabetes mellitus.

Pregnant women diagnosed with gestational diabetes mellitus subjected to diet (GDMd) that do not reach normal glycaemia are passed to insulin therapy (GDMi). GDMd associates with increased human cationic amino acid transporter 1 (hCAT-1)-mediated transport of L-arginine and nitric oxide synthase (NOS) activity in foetoplacental vasculature, a phenomenon reversed by exogenous insulin. Whether insulin therapy results in reversal of the GDMd effect on the foetoplacental vasculature is unknown.

Umbilical artery half peak systolic velocity deceleration time throughout pregnancy and its role in fetuses with bradycardia.

Objectives: To describe a new technique for Doppler waveform quantification of the fetal umbilical artery, the half peak systolic velocity (h-PSV) deceleration time, which measures the time that it takes a single flow velocity waveform to halve its maximum systolic velocity. As this measurement is independent of fetal heart rate, its role in the evaluation of placental vascular resistance in fetuses with bradycardia was also explored.

Methods: The umbilical artery impedance indices and the h-PSV deceleration time were measured in 532 normal singleton fetuses from 17 to 41 weeks of gestation.

[Invasive mole with uterine rupture].

A case of chorioadenoma destruens with uterine rupture is reported. The patient was admitted because a persistent uterine bleeding after abortion about two months before. The titulation of gonadotrophic hormone resulted in 25,000 unities.

[First arch syndrome: ultrasonic diagnosis].

A facial malformation was diagnosed by ultrasonography, the case correspond to First Arch syndrome, the findings are micrognathia, polyhydramnios, low-set ears and absence of stomach bubble. The heterogeneity of this syndrome and his relationship with environmental agents is analyzed.