Active Compared With Expectant Delivery Management in Women With Gestational Diabetes

Witkop, Catherine; Neale, Donna M; Wilson, Lisa M; Bass, Eric B.; Nicholson, Wanda K

doi:10.1097/aog.0b013e31818db36f

Cited by 86 publications

(45 citation statements)

References 10 publications

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“…A number of studies advocating superiority of active management of peripartum period in women with GDM suggested 38 th week as the most favourable time to perform induction and preinduction in terms of neonatal complications [18][19][20][21]. Due to existing data that elective induction of labour in patients with mild GDM does not increase the risk of caesarean section until the end of the 40 th gestational week, the most common recommendation is to perform induction on qualified patients between 38 th and 40 th gestational week [11,22].…”

Section: Discussionmentioning

confidence: 99%

Labour in women with gestational diabetes mellitus

et al. 2017

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Objectives: Gestational diabetes mellitus (GDM) constitutes one of the most common pregnancy complications and affects 3-5% of all pregnancies, with its incidence still growing. Due to possible maternal and fetal complications, the peripartum management of GDM patients continues to be a debatable issue. The aim of the study was to analyse the course and final way of delivery in women with gestational diabetes mellitus. The effectiveness of induction of labour (IOL) was also assessed and factors predisposing to cesarean section were identified. Material and methods:The study group consisted of 204 women with GDM who delivered in the Academic Centre for Woman's and Neonate's Health in Warsaw over the years 2013 and 2014. The indications and ratios of elective and intrapartum cesarean sections were analysed. Patients qualified for induction of labour were compared depending on their final way of delivery. Results:Over a half of all deliveries in the study group (53%) were cesarean sections. Elective surgeries accounted for 70% of all cesarean sections, predominantly due to a history of previous operational deliveries. Only 12% of the study group developed spontaneous uterine contractions and delivered vaginally. A comparison of the vaginal delivery group (n = 96) with cesarean section group (n = 108) pointed to high pregestational BMI value and advanced maternal age as factors increasing the patient's risk for surgical delivery (p = 0.0000 and p = 0.048 accordingly). The comparison of women undergoing IOL vs. omen with spontaneous uterine contractions showed no increase in the ratio of intrapartum cesarean sections in the IOL group -in both subgroups vaginal delivery was achieved in 75% of cases. Conclusions:Patients with GDM are more likely to undergo cesarean section, but the implementation of induction of labour at term does not further aggravate this risk. Major risk factors for operational delivery in GDM population included: advanced maternal age, high pregestational BMI value and undergoing insulin therapy.

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Section: Discussionmentioning

confidence: 99%

Labour in women with gestational diabetes mellitus

et al. 2017

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“…The results showed that elective induction can significantly reduce the rate of LGA and shoulder dystocia, but due to immature cervical ripening of early induction, the failure rate increased. The elective induction at less than 38 weeks has a higher rate of vaginal delivery failure, which results with transit to cesarean section anyways [14]. The results of our study show that there is no difference in the rate of cesarean section, the rate of difficult birth, the incidence of macrosomia or the incidence of neonatal hypoglycemia whether delivered before or after 40 weeks.…”

Section: Discussionmentioning

confidence: 44%

“…In their comparison however the authors did not take into consideration the pregnancy outcomes nor the neonatal outcomes. Witkop et al [14] have reviewed a few studies and found that in case of GDM pregnancy with good glycemic control, the incidence of macrosomia and associated complications can be reduced if management is active (induction at term) rather than expectant. In 2015 NICE brought to the attention that there was no convincing evidence that GDM pregnancy with appropriately managed glycemia has still an increased risk of a stillbirth but there was sufficient evidence to recommend induction of labor prior to 40 weeks of gestation to reduce the risk of shoulder dystocia [15].…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal outcomes of pregnancy at 39 weeks and beyond with mild gestational diabetes mellitus

et al. 2017

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Objectives: The purpose of this study was to retrospectively analyze maternal and neonatal outcomes in pregnant women with mild gestational diabetes mellitus at 39 weeks compared to 40 weeks. Material and methods:Clinical data of 372 cases of mild gestational diabetes mellitus form First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively. There were 108 mild GDM patients that delivered at 40-40 +6 weeks in our research group, and 264 patients that delivered in 39-39 +6 weeks in the control group. Neonatal and maternal outcomes were compared between the two groups.Results: There was no difference between the two groups in the rate of cesarean section (42.6% vs. 45.5%, p = 0.614). The incidence of large for gestational age between the two groups was also not different (11.1% vs. 10.6%, p = 0.887). The rate of postpartum hemorrhage and shoulder dystocia of the two groups was not different either (p > 0.05). There was no significant difference in the incidence of fetal distress, neonatal asphyxia, neonatal pathological jaundice, neonatal hypoglycemia, and neonatal respiratory distress syndrome in the two groups (p > 0.05).Conclusions: There were no significant differences in adverse pregnancy outcomes and neonatal outcomes in women with mild gestational diabetes between deliveries at 39 and 40 weeks.

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“…Кесарево сечение в родах при крупном плоде прово-дится в среднем в 2 раза чаще, чем у рожениц со средней массой плода [10,13]. В проведенном исследовании число случаев кесарева сечения при массе плода 4000 г и более составило 30,3%, при родах нормотрофичным плодом -17,5%.…”

Section: Discussionunclassified