Endocrine Abstracts (2017) 49 EP485 | DOI: 10.1530/endoabs.49.EP485

Single standard labour tactic at 39-40 weeks in pregnancy with gestational diabetes - is it the best policy?

Ofelia Bettikher & Irina Zazerskaya

Federal Almazov North-West Medical Research Centre, Saint Petersburg, Russia.

Objective: To assess labour outcomes in pregnancies with gestational diabetes (GD) regarding different delivery tactics.

Design and methods: The retro- and prospective study evaluating labour outcomes included 443 age matched patients with GD had given birth during 2014 (1st group – n=251) and 2015 (2nd group – n=192) according to the two clinical protocols, respectively. Expectant management in 2014 was supposed to use until 39–40 weeks of gestation in the absence of any earlier delivery indications, in 2015 – until 40–41 weeks similarly. Statistical analysis was performed with SPSS 21.0 (SPSS Inc.) program. Statistical methods used: Student criteria for quantative analysis, χ2 criteria for quality analysis; P<0.05.

Results: Labour induction rate was lower in the second group: 13.5% (26 of 192), than in the first: 17.1% (43 of 251), thus the rate of spontaneous labour raised (74.9% (188 of 251) and 78.2% (150 of 192)). The rate of pre-arranged and urgent caesarian section, macrosomia, diabetic embryopathy did not significantly differ between groups, the same as dysthyroidism and fetal distress after induction of labour: 7% (3 of 43) and 9.3% (4 of 43) – in the first, 7.7% (2 of 26) and 11.5% (3 of 26) – in the second group, respectively. However, uterine inertia rate after induction was twofold lower in the second group comparing to the first one: 7% (3 of 43) and 15.4% (4 of 26), respectively.

Conclusion: Expectant management until 40–41 weeks in patients with GD in the absence of earlier delivery indications has led to the labour complications rate fall and spontaneous labour rate rise. Probably, single standard tactic for labour at 38–40 weeks in all patients with GD is not one of choice. Such management is preferable for high risk antenatal fetal death pregnancies: fetal distress, macrosomia, diabetic fetopathy or severe maternal conditions, first of all, preeclampsia.

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