Grabowska Klaudia, Stapińska-Syniec Angelika, Saletra Aleksandra, Jarmużek Patrycja, Bomba-Opoń Dorota
1st Department of Obstetrics and Gynaecology, Medical University of Warsaw..
Ginekol Pol. 2017;88(2):81-86. doi: 10.5603/GP.a2017.0016.
Gestational diabetes mellitus (GDM) constitutes one of the most common pregnancy complications and affects 3-5% of all pregnancies, with its incidence still growing. Due to possible maternal and fetal complications, the peripartum management of GDM patients continues to be a debatable issue. The aim of the study was to analyse the course and final way of delivery in women with gestational diabetes mellitus. The effectiveness of induction of labour (IOL) was also assessed and factors predisposing to cesarean section were identified.
The study group consisted of 204 women with GDM who delivered in the Academic Centre for Woman's and Neonate's Health in Warsaw over the years 2013 and 2014. The indications and ratios of elective and intrapartum cesarean sections were analysed. Patients qualified for induction of labour were compared depending on their final way of delivery.
Over a half of all deliveries in the study group (53%) were cesarean sections. Elective surgeries accounted for 70% of all cesarean sections, predominantly due to a history of previous operational deliveries. Only 12% of the study group developed spontaneous uterine contractions and delivered vaginally. A comparison of the vaginal delivery group (n = 96) with cesarean section group (n = 108) pointed to high pregestational BMI value and advanced maternal age as factors increasing the patient's risk for surgical delivery (p = 0.0000 and p = 0.048 accordingly). The comparison of women undergo-ing IOL vs. omen with spontaneous uterine contractions showed no increase in the ratio of intrapartum cesarean sections in the IOL group - in both subgroups vaginal delivery was achieved in 75% of cases.
Patients with GDM are more likely to undergo cesarean section, but the implementation of induction of labour at term does not further aggravate this risk. Major risk factors for operational delivery in GDM population included: advanced maternal age, high pregestational BMI value and undergoing insulin therapy.
妊娠期糖尿病（GDM）是最常见的妊娠并发症之一，影响3%至5%的妊娠，且其发病率仍在上升。由于可能出现母婴并发症，GDM患者的围产期管理仍然是一个有争议的问题。本研究的目的是分析妊娠期糖尿病女性的病程及最终分娩方式。同时评估引产（IOL）的有效性，并确定剖宫产的相关因素。
研究组由204例GDM女性组成，她们于2013年至2014年在华沙妇女与新生儿健康学术中心分娩。分析了择期剖宫产和产时剖宫产的指征及比例。根据最终分娩方式对符合引产条件的患者进行比较。
研究组超过一半（53%）的分娩为剖宫产。择期手术占所有剖宫产的70%，主要原因是既往有手术分娩史。研究组中只有12%出现自发性子宫收缩并经阴道分娩。阴道分娩组（n = 96）与剖宫产组（n = 108）的比较表明，孕前BMI值高和产妇年龄较大是增加患者手术分娩风险的因素（相应的p值分别为0.0000和0.048）。引产组与自发性子宫收缩组女性的比较显示，引产组产时剖宫产比例并未增加——两个亚组中75%的病例实现了阴道分娩。
GDM患者更有可能接受剖宫产，但足月引产并不会进一步增加这种风险。GDM人群手术分娩的主要风险因素包括：产妇年龄较大、孕前BMI值高以及接受胰岛素治疗。
