477608 tn?1238527958

IDDM;Swelling;Proteinuria; fetal echo shows hypertrophic cardiomyopathy

My daughter-in-law is 22wks, IDDM showing signs of pre-eclampsia (severe swelling,proteinuria) and fetal echo showed mild-mod hypertrophic cardiomyopathy. Hba1c was 10 at time of conception, now at 7+. Additionally mom is Rh neg; dad Rh pos
Dad (my son) is in Afghanistan not due to return until August.

I (paternal grandmother) had one child born with dTGA,ASD,VSD,Pulmonary stenosis...he went into full cardio-respiratory arrest 13 hours post PA banding at the age of 3 months 3+ weeks. He suffered significant brain damage. He passed away August 2005 at the age of 17 years 10 months.

Concern is focused on mom, but there is question of fetal morbidity/viability in the event of forced delivery.

As I understand it, any baby delivered <24 weeks is not considered viable. What are the morbidity rates given this set of circumstances if delivered between 24-34 weeks?

I want my son and daughter-in-law to make an informed decision. We (my son and I) know disabilities does not equal a life without value however, we also know the trials attached.

Thank you
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477608 tn?1238527958
Thank you so much for your response. I received a call from my daughter-in-law regarding her most recent 24 hour urine...protein = 167. I am feeling much more comfortable with her being 2000 miles away with her involving me as she is. Her B/P has been WNL, with her major symptoms being facial, bilateral extremity edema; 2-3+ protein on dipstick.

She has decided to take her leave of absence early to focus on her and the baby's health, primary focus on her BG. I am continuing to research morbidity 24-34 weeks. As I understand, if her Hba1c gets closer to normal, there is a chance the hypertophic cardiomyopathy may resolve to some degree prior to birth and if pre-term delivery is necessary, with this condition the baby has a greater chance of developing CHF.

Since she is in Oxnard, CA, I know she is a short distance away from some of the best medical care in the world. Thank you!
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527625 tn?1229489258
You are asking very thoughtful and complex questions about the decision making involved when both prematurity as well as other medical problems may be an issue.

Generally speaking, many institutions consider the edge of viability to be in the 23-24 week gestational age range.  This guidelines for resuscitating infants born at this extreme prematurity vary from institution to institution.  In terms of mortality, the vast majority of infants born at 23 weeks will not survive, and approximately 50% of infants born at 24 weeks survive.  The majority of survivors at 24 weeks will have some form of long term neurodevelopmental deficit, ranging from mild learning problems to severe mental retardation and cerebral palsy.

Complications from maternal diabetes such as the hypertrophic cardiomyopathy increases the risk of death and other illness.  In combination with extreme prematurity (less than or equal to 24 weeks), the prognosis for long term survival without any neurodevelopmental deficits is poor.

Decision making about the extent of intervention or palliative care will depend upon open discussion between the parents and the healthcare providers where your daughter-in-law receives her care.
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