Frequency of caesarean section in diabetic vs. non diabetic females undergoing induction of labour at term
Introduction: Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance recognized during pregnancy. Gestational diabetes is associated with adverse maternal and fetal outcome. Majority of patients with diabetes had induction of labour at term (≥37weeks) to prevent maternal and fetal morbidity especially shoulder dystocia, macrosomia and intrauterine fetal death at term
- To find frequency of gestational diabetes (GDM) in patients undergoing induction of labour.
- To compare the frequency of caesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour
Study Type; It was a descriptive case series conducted at the department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Duration of study was six months after approval from IRB.
Sample size; Sample size of 214 cases undergoing induction of labour at term during study period; calculated with 95%confidence level and 3.4% margin of error and taking expected percentage of GDM is 6.9%.
Sampling Technique; purposive sampling
214 females who will fulfill the inclusion criteria were enrolled in the study from labour room of Department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Induction of labour done with tab prostin 3mg single dose and patients having gestational diabetes were identified and frequency of caesarean section in Diabetic and non-diabetic calculated.
In current study, mean age of the patients was 27.8±4.4 years. Mean gestational age was 37.1±3.8 weeks and mean BMI was 28.6±4.1 kg/m2. Primigravida were 88 (41.1%) and multigravidas were 126 (58.9%). Gestational diabetes was found to be in 36 patients (16.8%). Caesarean section was performed in 77 patients (36%). Comparison of frequency of cesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour revealed majority of the caesarean sections performed in GDM patients (p=0.007).
In conclusion, our study found a higher incidence of cesarean section than normal delivery in pregnant women with gestational diabetes. Major factors for operational delivery in GDM population included: advanced maternal age and high BMI value.
1. Szmuilowicz ED, Josefson JL, Metzger BE. Gestational Diabetes Mellitus. Endocrinol Metab Clin North Am. 2019;48(3):479–93. DOI: 10.1016/j.ecl.2019.05.001
2. Bao W, Tobias DK, Hu FB, Chavarro JE, Zhang C. Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: Prospective cohort study. BMJ. 2016; doi: https://doi.org/10.1136/bmj.h6898
3. BARNES PH. Prediabetes and pregnancy. Can Med Assoc J. 1961;85:681–8.
4. Tobias DK, Zhang C, Van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: A meta-analysis. Diabetes Care. 2011;34(1):223–9. doi: 10.2337/dc10-1368
5. Khan N, Farooq N, Batool A, Altaf A. Frequency of gestational diabetes mellitus and associated risk factors. Rawal Med J. 2018;43(3):459–61.
6. Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for Caesarean section births in New South Wales, Australia: A population-based study. BMC Pregnancy Childbirth. 2011; https://doi.org/10.1186/1471-2393-11-8
7. Stock SJ, Ferguson E, Duffy A, Ford I, Chalmers J, Norman JE. Outcomes of elective induction of labour compared with expectant management: Population based study. BMJ. 2012;344(7857):1–13. doi: https://doi.org/10.1136/bmj.e2838
8. Centre NC. Induction of Labour. Lancet. 1940;236(6101):138.
9. Wood S, Cooper S, Ross S. Does induction of labour increase the risk of caesarean section? A systematic review and meta-analysis of trials in women with intact membranes. BJOG An Int J Obstet Gynaecol. 2014;121(6):674–85. DOI: 10.1111/1471-0528.12328
10. Torloni MR, Betrán AP, Horta BL, Nakamura MU, Atallah AN, Moron AF, et al. Prepregnancy BMI and the risk of gestational diabetes: A systematic review of the literature with meta-analysis: Diagnostic in Obesity and Complications. Vol. 10, Obesity Reviews. 2009. p. 194–203. DOI: 10.1111/j.1467-789X.2008.00541.x
11. Li G, Wei T, Ni W, Zhang A, Zhang J, Xing Y, et al. Incidence and Risk Factors of Gestational Diabetes Mellitus: A Prospective Cohort Study in Qingdao, China. Front Endocrinol (Lausanne). 2020 Sep 11;11.
12. Zaman N, Taj N, Nazir S, Ullah E, Fatima N. Gestational Diabetes Mellitus and Obesity: An experience at a teaching hospital in Bahawalpur,Pakistan. Rawal Med J 2013;38:165-8
13. Bibi S, Saleem U, Mahsood N. THE FREQUENCY OF GESTATIONAL DIABETES MELLITUS AND ASSOCIATED RISK FACTORS AT KHYBER TEACHING HOSPITAL PESHAWAR. Vol. 29.
14. Vahratian A, Zhang J, Troendle JF, Sciscione AC, Hoffman MK. Labor progression and risk of cesarean delivery in electively induced nulliparas. Obstet Gynecol. 2005 Apr;105(4):698–704. DOI: 10.1097/01.AOG.0000157436.68847.3b
15. Darney BG, Snowden JM, Cheng YW, Jacob L, Nicholson JM, Kaimal A, et al. Elective induction of labor at term compared with expectant management : Maternal and neonatal outcomes. Obstet Gynecol. 2013 Oct;122(4):761–9. doi:10.1097/AOG.0b013e3182a6a4d0.
16. Caughey AB, Nicholson JM, Cheng YW, Lyell DJ, Washington AE. Induction of labor and cesarean delivery by gestational age. Am J Obstet Gynecol. 2006 Sep;195(3):700–DOI: 10.1016/j.ajog.2006.07.0035.
17. Bailit JL, Grobman W, Zhao Y, Wapner RJ, Reddy UM, Varner MW, et al. Nonmedically indicated induction vs expectant treatment in term nulliparous women. Am J Obstet Gynecol. 2015 Jan 1;212(1):103.e1-103.e7. . doi:10.1016/j.ajog.2014.06.054
18. Bergsø P, Halle C. Duration of the Second Stage of Labor. Acta Obstet Gynecol Scand. 1980;59(3):193–6.
19. Practice_Bulletin_No__137__Gestational_Diabetes.46. DOI: 10.1097/01.AOG.0000433006.09219.f1
20. Conway DL, Langer O, Antonio S. Elective delivery of infants with macrosomia in diabetic women: Reduced shoulder dystocia versus increased cesarean deliveries. 1998. https://doi.org/10.1016/S0002-9378(98)70524-1
21. Lurie S, Insler V, Hagay Z. INDUCTION OF LABOR AT 38 TO 39 WEEKS OF GESTATION REDUCES THE INCIDENCE OF SHOULDER DYSTOCIA IN GESTATIONAL DIABETIC PATIENTS CLASS A2. Vol. 13, AMERICAN JOURNAL OF PERINATOLOGY. 1996. DOI: 10.1055/s-2007-994344
22. Sutton AL, Mele L, Landon MB, Ramin SM, Varner MW, Thorp JM, et al. Delivery timing and cesarean delivery risk in women with mild gestational diabetes mellitus. In: American Journal of Obstetrics and Gynecology. Mosby Inc.; 2014. p. 244.e1-244.e7.doi:10.1016/j.ajog.2014.03.005.
23. David Naylor C, Sermer M, Chen E, Sykora K. Cesarean Delivery in Relation to Birth Weight and Gestational Glucose Tolerance Pathophysiology or Practice Style? [Internet]. Available from: http://jama.jamanetwork.com/
24. Jovanovič L, Savas H, Mehta M, Trujillo A, Pettitt DJ. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Diabetes Care. 2011 Jan;34(1):53–4. DOI: 10.2337/dc10-1455
25. Naheed F, Kammeruddin K, Hashmi HA, Narijo S. Frequency of Impaired Oral Glucose Tolerance Test in High Risk Pregnancies for Gestational Diabetes Mellitus. J Coll Physician Surg Pak 2008;18:82-5.
Copyright (c) 2021 Fozia Umber Quraishi, Saima Jabeen, Anum Yousaf, Rukhsana Gulzar
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
All research articles published in the Journal of Rawalpindi Medical College (JRMC) are fully open access: immediately freely available to read, download, and share. Copyrights of all articles published in JRMC are retained by the authors. First publication rights are granted to JRMC. The journal/publisher is not responsible for subsequent uses of the work.
All articles are published under the Creative Commons Attribution (CC BY-SA 4.0) license.