Women may experience genital trauma during
CHILDBIRTH, particularly with vaginal delivery of a
breech presentation (baby born bottom first) or a
large baby. Some women have birth-related trau-
matic tearing of the perineum, and others have
episiotomy in an attempt to limit the extent of
trauma or enlarge the vaginal opening to allow
the baby to pass. The resulting injuries may
require surgical repair and sometimes result in
long-term complications affecting urinary conti-
nence, fecal continence, and pleasure during sex-
ual intercourse.
Female ritual genital mutilation, also called
female circumcision, remains common in some
cultures despite widespread opposition from the
World Health Organization (WHO), Amnesty
International, and other health and human rights
organizations worldwide. Within such cultures rit-
ual genital mutilation may be a rite of passage, a
mark of ownership, or a religious practice con-
ducted in early childhood by nonmedical practi-
tioners, without ANESTHESIA and often under
unsanitary conditions. Complications are common
and often severe. WHO and other organizations
have made it a goal to eliminate ritual genital
mutilation worldwide.
See also PRIAPISM; TESTICULAR TORSION;
VULVODYNIA.
gestational diabetes The development of INSULIN
RESISTANCE or type 2 DIABETES during PREGNANCY.
Gestational diabetes develops between 24 and 28
weeks of pregnancy. Doctors believe the rising lev-
els of hormones the PLACENTA produces at this
point in pregnancy interfere with the ability of the
woman’s body to properly metabolize INSULIN.
Insulin production remains normal. Diabetes that
manifests earlier than 24 weeks in pregnancy is
nearly always diabetes that was undetected at the
start of the pregnancy. Gestational diabetes goes
away shortly after delivery, though women who
have gestational diabetes have increased risk for
developing type 2 diabetes later in life.
Untreated gestational diabetes poses a health
risk primarily for the FETUS. The excessive GLUCOSE
(sugar) that circulates in the mother’s BLOOD
crosses the placenta. When it reaches the fetus the
excessive glucose fuels fetal growth, resulting in
fetal size up to 20 percent greater than normal.
This growth becomes problematic within the
UTERUSas the fetus cannot move as freely. Ade-
quate prenatal movement is important for proper
muscular development. A fetus larger than about
eight pounds often has difficulty passing through
the birth canal. The circumstance of an overly
large fetus, called macrosomia, often necessitates
birth by CESAREAN SECTION (surgical delivery) to
safeguard the health of both baby and mother. As
well, the newborn infant may experience HYPO-
GLYCEMIA(low blood glucose) in the first hours
after birth.Symptoms and Diagnostic Path
Most often gestational diabetes has few noticeable
symptoms. When symptoms do occur they may
include frequent URINATION, increased thirst, and
increased hunger. Because these are common in
pregnancy, however, they are difficult to distin-
guish as symptoms of diabetes. Routine URINEtests
at each prenatal doctor visit screen for the over-
flow of glucose in the urine, which indicates high
blood glucose. Health-care providers routinely test
for elevated glucose in the woman’s blood circula-
tion between the 24th and 28th weeks of preg-
nancy. The most common such test is the
three-hour glucose tolerance test. Findings of an
elevated blood glucose level at two or more of the
four drawings of blood over the course of the test
generally establishes the diagnosis of gestational
diabetes.Treatment Options and Outlook
Many women are able to manage gestational dia-
betes through nutritional EATING HABITSand daily
exercise. Women for whom lifestyle measures do
not maintain stable blood glucose levels typically
require insulin injections through the remainder
of pregnancy. The safety of oral antidiabetes med-
ications in pregnancy remains undetermined,
though some doctors offer this treatment. Diligent
management of blood glucose levels helps main-
tain normal growth and weight of the fetus.
In nearly all women gestational diabetes goes
away within a week of delivery and for a third of
women diabetes is never again a health concern.
However, in some women who have high risk for
diabetes in the first place gestational diabetes may
persist to become conventional diabetes. One in288 The Reproductive System