title: Pregnancy in a woman with class H diabetes mellitus and previous coronary artery bypass graft: a case report and review of the literature.
abstract: BACKGROUND
  Maternal and fetal mortality have been reported to be high in pregnant women with diabetes mellitus and ischemic heart disease. Review of the literature identified only two cases of pregnancy after coronary artery bypass surgery in diabetic patients. Because of limited case experience, there are no clear recommendations for counseling and managing such patients.
  
  
  METHODS
  We managed a pregnancy complicated by class H diabetes mellitus in which the patient had an earlier need for four-vessel coronary artery bypass surgery. The application of contemporary techniques for diabetic and cardiac management led to successful maternal and perinatal outcomes at 36 weeks' gestation.
  
  
  CONCLUSIONS
  Preconception coronary artery bypass surgery, along with contemporary medical and obstetric management, may lead to improvement in the outcome of pregnancies complicated by class H diabetes.
authors.affiliation: Department of Obstetrics and Gynecology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
authors.forename: X
authors.initials: X
authors.lastname: Pombar
authors.forename: H T
authors.initials: HT
authors.lastname: Strassner
authors.forename: P C
authors.initials: PC
authors.lastname: Fenner
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass; D003922:Diabetes Mellitus, Type 1; D005260:Female; D006801:Humans; D017202:Myocardial Ischemia / Q000601:surgery*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics