Indications for and timing of delivery in diabetic pregnancies.
The management of 430 diabetic pregnancies is presented. Our protocol emphasized "tight" metabolic control and assessment of fetal well-being by antepartum fetal heart rate testings and estriol levels. Spontaneous labor was allowed in uncomplicated Class A diabetic patients. Labor in complicated cases and insulin-dependent diabetic pregnancies was induced after establishing fetal lung maturity, except when a maternal or fetal complication dictated otherwise. A significant drop in estriol was observed in 4% of Class A diabetic patients and 10.2% of insulin-dependent diabetic patients. None developed a positive contraction stress test. Abnormal fetal well-being tests contributed minimally to the indications for induction of labor. The incidence of induced preterm delivery was 2.8% in Class A diabetic patients and 18.4% in insulin-dependent diabetic ones. The perinatal mortality was 5.6:1000 and 13:1000, respectively. The incidence of respiratory distress syndrome was very low, and none of the cases were associated with a "mature" amniotic fluid lecithin phosphorus measurement.
D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D004964:Estriol / Q000097:blood; D005260:Female; D005318:Fetal Heart / Q000502:physiology*; D005325:Fetal Organ Maturity; D006339:Heart Rate; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D008168:Lung / Q000196:embryology; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000628:therapy*; D013997:Time Factors
D004964:Estriol