Induction of labor versus conservative management of pregnant diabetic women.
Reasons for inducing labor at term in pregnancies complicated by diabetes include the avoidance of fetal demise and the prevention of excessive fetal growth and its concomitant conditions, shoulder dystocia and Cesarean delivery. Objectively evaluating the risks and benefits of labor induction is potentially confounded by the status of the cervix at the time of initiation of induction, early determination of an arrest disorder and physician bias toward Cesarean delivery for women who have diabetes. In non-diabetic women, incorporating estimates of fetal weight in deciding the route of delivery has not diminished the incidence of shoulder dystocia, and may have increased the incidence of Cesarean deliveries. Currently available evidence suggests that, while induction of labor for women who have diabetes may not carry much maternal or fetal risk, the benefit of this procedure is unclear.
Sacks
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Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Kaiser Foundation Hospital, Bellflower, California 90706, USA.
Sacks
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A
D001720:Birth Injuries / Q000517:prevention & control; D002584:Cervix Uteri / Q000502:physiology; D002585:Cesarean Section; D004420:Dystocia / Q000517:prevention & control; D005260:Female; D005313:Fetal Death / Q000517:prevention & control; D005320:Fetal Macrosomia / Q000517:prevention & control; D020567:Fetal Weight / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000150:complications*; D012782:Shoulder