Kjos S L, Henry O A, Montoro M, Buchanan T A, Mestman J H
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles.
Am J Obstet Gynecol. 1993 Sep;169(3):611-5. doi: 10.1016/0002-9378(93)90631-r.
Our purpose was to assess whether a program of expectant management of uncomplicated pregnancies in mothers with insulin-requiring gestational or pregestational class B reduces the incidence of cesarean birth.
Two hundred women with uncomplicated, insulin-requiring diabetes at 38 weeks' gestation who were compliant with care and whose infants were judged appropriate for gestational age were randomly assigned to (1) active induction of labor within 5 days or (2) expectant management. The expectant management group was monitored with weekly physical examination and twice-weekly nonstress tests and amniotic fluid volume estimation until delivery.
Expectant management increased the gestational age at delivery by 1 week. Approximately half (49%) of the mothers in the expectant management group required induction of labor for obstetric indications. The cesarean delivery rate was not significantly different in the expectant management group (31%) from the active induction group (25%). The mean birth weight (3672 +/- 407 gm) and percentage large for gestational age, as defined by birth weight > or = 90th percentile, of infants in the expectantly managed group (23%) was greater than those in the active induction group (3466 +/- 372 gm, p < 0.0001, 10% large for gestational age). This difference persisted after controlling for gestational age and maternal age and body weight (p < 0.01).
In women with uncomplicated insulin-requiring gestational or class B pregestational diabetes, expectant management of pregnancy after 38 weeks' gestation did not reduce the incidence of cesarean delivery. Moreover, there was an increased prevalence of large-for-gestational-age infants (23% vs 10%) and shoulder dystocia (3% vs 0%). Because of these risks, delivery should be contemplated at 38 weeks and, if not pursued, careful monitoring of fetal growth must be performed.
我们的目的是评估对于患有胰岛素依赖型妊娠期或孕前B级糖尿病的母亲，对其无并发症的妊娠进行期待管理的方案是否能降低剖宫产的发生率。
200名妊娠38周、患有无并发症的胰岛素依赖型糖尿病、依从治疗且其婴儿被判定为适于胎龄的女性被随机分为两组：（1）在5天内积极引产；（2）期待管理。期待管理组每周进行体格检查，每周进行两次无应激试验及羊水容量评估，直至分娩。
期待管理使分娩时的孕周增加了1周。期待管理组中约一半（49%）的母亲因产科指征需要引产。期待管理组（31%）与积极引产组（25%）的剖宫产率无显著差异。期待管理组婴儿的平均出生体重（3672±407克）以及根据出生体重≥第90百分位数定义的大于胎龄儿百分比（23%）高于积极引产组（3466±372克，p<0.0001，大于胎龄儿为10%）。在控制孕周、母亲年龄和体重后，这种差异仍然存在（p<0.01）。
对于患有无并发症的胰岛素依赖型妊娠期或孕前B级糖尿病女性，妊娠38周后进行期待管理并不能降低剖宫产的发生率。此外，大于胎龄儿（23%对10%）和肩难产（3%对0%）的发生率有所增加。鉴于这些风险，应考虑在38周时分娩，若不进行，则必须密切监测胎儿生长情况。
