Managing labor and delivery of the diabetic mother

Emergency Department Pre-Viability Delivery of a Fetus En Caul

“…When intact amniotic membranes are observed in the vaginal introitus, initial instinct may be to replace the intact amnion inside the uterus, however, replacement is never a viable pathway as infection risk to the pregnant patient is great. It is within the purview of emergency medicine providers to manage extreme preterm precipitous delivery in the emergency department [ 10 ]. En caul presentation adds an extra layer of complexity, however, management of extreme preterm precipitous delivery is the same, regardless of membrane rupture.…”

“…Expectant management involves nonintervention, allowing a pregnancy to progress as expected, including spontaneous labor [ 10 ]. Expectant management of a premature fetus can be difficult for the emergency medicine physician, in particular, when it occurs at an age of peri-viability.…”

A comparison of the clinical outcomes of induced and spontaneous labour in patients with gestational diabetes

“…• крупный плод (более 90 процентиля для данного срока гестации или более 4 кг); • увеличение толщины подкожного жирового слоя у плода, увеличение буккального коэффициента; • кардиомегалия, кардиопатия (кардиоторакальный индекс более 25%, утолщение межжелудочковой пе-регородки); • гепатомегалия, спленомегалия; • гиперплазия коры надпочечников плода (увеличение надпочечникового коэффициента более 1,2); • гиперплазия поджелудочной железы плода [4,5,6].…”

Evidence‐Based Strategies for Managing Gestational Diabetes in Women With Obesity

“…If a pregnant woman with GDM and obesity has experienced good glycemic control throughout her pregnancy, there is insufficient evidence and no medical indication to contradict the recommendation against elective induction of labor before 39 weeks gestation (ACOG Committee on Practice Bulletins—Obstetrics, ; March of Dimes, n.d.). Expectant management should be utilized in women with normal estimated fetal weight, good glycemic control, reassuring antenatal testing and normal amniotic fluid levels (Sela, Raz, & Elchalal, ). After 32 weeks gestation, non‐reassuring antenatal testing or an abnormal fetal kick count as reported by the patient may indicate that delivery could be considered (Seri & Evan, ; Sugiyama, ).…”

“…However, if macrosomia with estimated fetal weight > 4,000 g via ultrasound is suspected, delivery should be considered between 38 and 39 weeks to reduce the risk of shoulder dystocia from 10 percent to 1.4 percent (Menato et al., ). If estimated fetal weight is >4,250 g, cesarean should be considered to decrease the likelihood of shoulder dystocia, postpartum hemorrhage, third‐ and fourth‐degree lacerations and maternal infections (Sela et al., ). Currently, research is ongoing to compare maternal and neonatal outcomes in scheduled inductions between 38 and 39 weeks gestation and expectant management for women with GDM (Maso et al., ).…”