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Arch Gynecol Obstet. 2014 Nov;290(5):905-12. doi: 10.1007/s00404-014-3313-6. Epub 2014 Jun 28.

Elective induction of labor in women with gestational diabetes mellitus: an intervention that modifies the risk of cesarean section.

Author information

1
Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Affiliated with the Hebrew University Hadassah School of Medicine, Jerusalem, Israel, orenandmaayan@gmail.com.

Abstract

AIM:

To evaluate the effect of elective induction at term for women with gestational diabetes mellitus (GDM) on the risk for cesarean delivery.

STUDY DESIGN:

This is a retrospective case-control matched study, based on a single-center computerized database, 2005-2011. The medical records were reviewed for GDM management and glycemic control. For the study, two groups were defined: Group 1, women diagnosed with GDM with an estimated fetal weight <4,000 g, electively induced at term; Group 2, women induced due to Term-PROM, an indication for term induction in normoglycemic women with uncomplicated pregnancies, matched for age and parity (ratio 1:2). The primary outcome was cesarean delivery and secondary outcomes included other maternal and neonatal events. Descriptive analyses and multivariate analyses models were fitted.

RESULTS:

GDM was diagnosed in 1,873 (2.6 %) women of 72,374 births; 227 (12.1 %) were eligible for inclusion in Group 1 and matched with 454 women in Group 2. GDM management included diet in 103 (45.4 %), insulin in 81 (35.7 %), and oral hypoglycemic agents in 43 (18.9 %).The cesarean delivery rate was significantly higher in Group 1, 17.1 vs. 11.2 % (p = 0.02). Three out of four births complicated by shoulder dystocia and BW <4,000 g, occurred in Group 1 (p = 0.076) and were associated with no glycemic control. Other obstetrical-related outcomes such as instrumental birth, severe perineal tears, early postpartum hemorrhage and peripartum transfusion were similar between groups.

CONCLUSION:

Elective induction at term for women with GDM is associated with an increased risk for cesarean delivery as compared to other elective induction of labor.

PMID:
24973018
DOI:
10.1007/s00404-014-3313-6
[Indexed for MEDLINE]

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