[Obstetrical behaviour in diabetes. Perinatal mortality (author's transl)].

Ever today diabetes and pregnancy constitute a high risk situation of the mother as well for the fetus, since still high maternal-fetal mortality rates are observed. A series of 134 diabetic women (99 type A, 15 type B, and 20 type C) were evaluated during pregnancy and delivery, and the results obtained during two different periods of time (1972-1975 and 1976-1978) are analyzed. From the results obtained the reduction of the indexes of perinatal mortality (before and after birth) stands out. These facts could probably be related to a change in the protocol applied during the last years and consisting in the administration of a carbohydrate supplement at night in order to avoid nocturnal hypoglycemias, admission of patients after the 32nd-34th week of pregnancy, complete rest in bed, control of the maturity of the fetus, etc. Likewise, there was a lack of significant rise in the presence of macrosomias, premature births, or urinary infection in the mother. As it was to be expected, the incidence of hydramnios as well as toxemia was higher than normal. The evaluation of the newborns through the Apgar score proved that 20 percent of the neonates in the type C diabetes were still partially or seriously depressed after 5 minutes of birth. A protocol of assistance in this special situation affords an evident reduction in perinatal mortality.