Caudal Regression Syndrome and Maternal Diabetes Mellitus

Abstract

A  32 – years – old primigravida (GA 32⁺⁶ wks. by U/S in Tapanhin Crown Prince  Hospital, 35⁺⁴ wks. by dates) had  past  medical  history of Diabetes Mellitus (DM) since 2006  but  no history of treament  before.  She had the first visit antenatal  care  at  18⁺⁴ wks  by U/S  in hospitals  at Nakhon  Ratchasima  Province. Results of oral glucose tolerance test (OGTT) was Gestational DMA₂(GDMA₂) but she had history  DM  before  pregnancy.  Final  diagnosis  was  Pregestational DM with Thalassemia  carrier.  A  sonogram  revealed  normal, no anomalies at  18⁺⁴wks.  Her  past  medical  treament  had  not  successful  because  of  poor  control  of  blood  glucose  and  loss  follow  up.  A  2700 – grams, Near –term male  infant  was  born  by spontaneous vaginal delivery  in  Tapanhin  Crown  Prince Hospital.  Apgar  score  was 9  at 1  minute  and  10 at 5 minutes.  No intrapartum  and  postpartum  complications. The infant had his lower limbs showed  muscle  atrophy  and  shortening , talipes  equinovarus  Lt  foot.  There  was  fixed  flexion  and  adduction of  hips, and  fixed  extension  of  the  knees.  The  anus  was  in  the  posterior with diminished tone and dribbing of urine. These  anomalies  was  Caudal  Regression  Syndrome.  There was  undescended  Lt  testis  and  fracture  Lt  femur. Long term  treatment  is  difficult, multidisciplinary, and  largely  supportive  in  long  term  management.