A diabetic female at 40 weeks of gestation delivered a baby by elective cesarean section. Soon after birth the baby developed respiratory distress. The diagnosis is:
Correct Answer: Transient tachypnea of the newborn
Description: Ans. is a, i.e. Transient tachypnea of the newbornRef. Ghai 6/e, p 166, 168; COGDT 10/e, p 316; Williams Obs. 22/e, p 1178, 23/e, p 1116Friends don't get shocked by the answer, even I was perplexed when I went through the texts given in all the standard reference books.Let's see what they have said.Respiratory distress syndrome (RDS) or hyaline membrane disease (HMD) --Ghai 6/e, p 166RDS almost always occurs in preterm babies often less than 34 weeks of gestation.It is the commonest cause of respiratory distress in a preterm neonate.According to Ghai - RDS is seen in preterm babies and not the term babies (as is given in our question).Now let's see what Ghai says about transient tachypnea of newborn;Transient tachypnea of newborn (TTN) --Ghai 6/e, p 168Transient tachypnea of the newborn is a benign self-limiting disease occurring usually in term neonates and is due to delayed clearance of lung fluid.These babies have tachypnea with minimal or no respiratory distress.Chest X-ray may show prominent vascular marking and prominent interlobar fissure.Oxygen treatment is often adequate and ventilatory support is necessary and prognosis is good.But Ghai didn't mention any correlation between TTN and Diabetes. So, I had to search other books for more information. COGDT 10/e, p 316 says:Neonatal complications: RDS and transient tachypnea are more common in infants of women with poorly controlled diabetics.In this way we can derive some correlation between diabetes and TTN.Our answer is further strengthened by Williams Obs. 22/e, p 1178, 23/e, p 1116 which says -Respiratory distress:"Conventional obstetrical teaching through the late 1980s generally held that fetal lung maturation was delayed in diabetic pregnancies. Thus, these infants were at increased risk for respiratory distress (Gluck and Kulovich, 1973). Subsequent observations have challenged this concept, and gestational age rather than overt diabetes is likely the most significant factor associated with neonatal respiratory distress (Berkowitz and colleagues, 1996; Kjos and colleagues, 1990b)".So, it is the gestational age and not diabetes which is the main factor causing neonatal respiratory distress.In our question the baby is delivered at 40 weeks gestation (Full term) so, the answer cannot be Hyaline membrane disease rather it is transient tachypnea of newborn (i.e. option 'a' is correct).
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Gynaecology & Obstetrics
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