McAuliffe F M, Foley M, Firth R, Drury I, Stronge J M
National Maternity Hospital, Dublin, Ireland.
Ir J Med Sci. 1999 Jul-Sep;168(3):160-3. doi: 10.1007/BF02945844.
One hundred and forty-eight patients with well controlled insulin dependent diabetes that were allowed to labour spontaneously from 1981 to 1994 were reviewed. There were 2 perinatal deaths, giving a perinatal mortality rate of 13.5/1000. One hundred and twenty-four patients (84 per cent) had a normal vaginal delivery, 13 (9 per cent) forceps delivery and 11 (7 per cent) caesarean section. Twenty-one infants (14 per cent) required admission to a Special Care Baby Unit. One third of infants weighed 4 Kg or more, however there was only 1 case of shoulder dystocia. We compared these results with those of the general hospital population of 1987. The 2 main differences are; 1) the Caesarean section rate in labour was higher for this diabetic group than for the general hospital population, 7 per cent versus 3.4 per cent, 2) the birth weight was heavier, 33 per cent of infants of the diabetic group weighed 4 Kg or more versus 18 per cent of the general hospital population. The other parameters were comparable. We conclude that conservative management of pregnancy in well controlled diabetic women is advantageous, resulting in a high vaginal delivery rate without an increase in shoulder dystocia, and a low perinatal morbidity and mortality rate.
回顾了1981年至1994年间148例胰岛素依赖型糖尿病控制良好且自然分娩的患者。围产期死亡2例，围产儿死亡率为13.5/1000。124例（84%）患者经阴道正常分娩，13例（9%）产钳助产，11例（7%）剖宫产。21例婴儿（14%）需入住特殊护理婴儿病房。三分之一的婴儿体重4千克或以上，但仅1例肩难产。我们将这些结果与1987年综合医院人群的结果进行了比较。两个主要差异在于：1）该糖尿病组的分娩剖宫产率高于综合医院人群，分别为7%和3.4%；2）出生体重更重，糖尿病组33%的婴儿体重4千克或以上，而综合医院人群为18%。其他参数具有可比性。我们得出结论，对控制良好的糖尿病孕妇进行保守管理是有利的，可实现较高的阴道分娩率，且不增加肩难产，围产期发病率和死亡率也较低。
