Critical Care Obstetrics part 74 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Pregnancy in Women with Complicated Diabetes Mellitus 3 Active proliferative retinopathy should ideally be treated before pregnancy. If it develops in early gestation first trimester and there is no response to treatment pregnancy termination might have to be offered as an alternative. 4 Vaginal delivery may be allowed for those patients with background or successfully treated proliferative retinopathy. The optimal route of delivery for those patients with active proliferative retinopathy has not been determined since in non-pregnant patients vitreous hemorrhages may occur even during periods of inactivity. Vitreous hemorrhages have been observed during both cesarean sections and vaginal deliveries but there is concern that they may occur more readily during the active expulsion phase of vaginal birth. In patients with active proliferative retinopathy it is recommended that the mode of delivery be determined on an individual basis and in consultation with both the obstetrician and ophthalmologist. Nephropathy Until fairly recently women with diabetic nephropathy were strongly discouraged from attempting pregnancy and therapeutic abortion was frequently recommended if pregnancy occurred. These recommendations are not supported by more recent reports which show significantly improved perinatal outcome when good metabolic and blood pressure control is achieved along with current state of the art obstetric and neonatal care. Better outcomes are consistently obtained in centers offering a multidisciplinary team approach. Perinatal complications may include congenital anomalies fetal growth restriction fetal death stillbirth and preterm delivery with its associated neonatal morbidity from prematurity. Maternal complications include worsening of renal function during or after pregnancy anemia superimposed pre-eclampsia or eclampsia and worsening of other diabetic complications frequently coexisting with nephropathy mainly retinopathy see previous section . These women .
