Rasmussen M J, Firth R, Foley M, Stronge J M
National Maternity Hospital, Dublin, Ireland.
Aust N Z J Obstet Gynaecol. 1992 Nov;32(4):313-7. doi: 10.1111/j.1479-828x.1992.tb02841.x.
The approach of term in the pregnancy of a diabetic woman is a time of anxiety for patient and physician alike. The impact of a conservative approach to the timing of delivery is outlined in this review of the clinical course and outcome of 276 pregnancies of diabetic women, delivered at the National Maternity Hospital, Dublin between 1981 and 1990. The mean gestation at delivery was 39 weeks, 229 patients (83%) delivered at or beyond 38 weeks and 112 patients (41%) delivered at or beyond 40 weeks. The overall induction of labour rate was 27% and the elective Caesarean section rate was 19%. Sixty seven percent of patients achieved a normal delivery, the forceps rate was 5%, and 28% of patients were delivered by Caesarean section. There were 16 perinatal deaths in the series, with 7 due to lethal malformations. There were 5 deaths of normally formed infants occurring at or beyond 38 weeks' gestation. All of these 5 deaths had been preceded by clinically apparent polyhydramnios or macrosomia and recognized poor control. This study stresses the value of strict diabetic control in the management of diabetic pregnancy and highlights the significance of polyhydramnios and macrosomia as indicators of risk approaching term in diabetic pregnancy.
糖尿病孕妇接近足月时，患者和医生都会感到焦虑。本文回顾了1981年至1990年在都柏林国家妇产医院分娩的276例糖尿病孕妇的临床过程和结局，概述了保守分娩时机方法的影响。分娩时的平均孕周为39周，229例患者（83%）在38周及以后分娩，112例患者（41%）在40周及以后分娩。总的引产率为27%，择期剖宫产率为19%。67%的患者顺产，产钳助产率为5%，28%的患者通过剖宫产分娩。该系列中有16例围产期死亡，其中7例死于致命畸形。有5例正常发育的婴儿在妊娠38周及以后死亡。这5例死亡之前均有临床上明显的羊水过多或巨大儿，且已知血糖控制不佳。本研究强调了严格控制糖尿病在糖尿病妊娠管理中的价值，并突出了羊水过多和巨大儿作为糖尿病妊娠接近足月时风险指标的重要性。
