title: Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome--a single center experience.
abstract: OBJECTIVE
  To evaluate the mode of delivery in diabetic pregnancies at term following induction of labor with vaginal application of prostaglandin E2 (PGE2), and to identify possible predictors of successful vaginal delivery.
  
  
  METHODS
  The study group consisted of 105 women with diabetic pregnancies at term admitted for induction of labor; 84 (80%) had gestational diabetes (GDM) and 21 (20%) type 1 diabetes. Findings were compared with women who underwent elective induction of labor (n=115), and women with normal spontaneous onset of labor (n=510). Women with previous cesarean section (CS) were excluded from both study and control groups.
  
  
  RESULTS
  Maternal age and gravidity were significantly higher in the study group than the control groups (age: 31.4+/-5, 28+/-5.0 and 28.1+/-4.8 years, respectively; gravidity: 3.0+/-1.9, 2.5+/-1.6, and 2.1+/-1.4, respectively; P<0.001 for both) and gestational age and nulliparity rate were significantly lower (gestational age: 38.6+/-1.1, 40.2+/-1.3 and 39.3+/-2.7 weeks, respectively; nulliparity: 34.6, 45.2, 51.6%, respectively; P<0.002 for both). There were no between-group differences in the incidence of oligohydramnios, number of PGE2 applications used, birth weight, rate of non-reassuring fetal heart rate pattern leading to CS, and rate of low 5 min Apgar score (<7). The rate of CS in the study group (18.2%) was significantly higher than in the spontaneous labor group (9%) but similar to the elective induction group (14.8%). On stepwise analysis, only nulliparity (OR 4.56, 95% CI 1.11-18.67, P=0.035) was independently and significantly associated with increased risk of CS. Within the study group (R2=0.257, P=0.002), type 1 diabetes (OR 2.4, 95% CI 1.04-5.51) was independently and significantly associated with increased risk of CS.
  
  
  CONCLUSIONS
  In diabetic pregnancies, induction of labor at term with vaginal PGE2 is successful in approximately 82% of patients, but yields a significantly higher CS rate compared to uncomplicated pregnancies. Nulliparity and diagnosis of type 1 diabetes are independently and significantly associated with increased risk of CS.
  
  
  CONCLUSIONS
  In diabetic pregnancies, induction of labor at term is successful in 82% of patients, but yields higher CS rates compared to uncomplicated pregnancies.
authors.affiliation: Perinatal Division and WHO Collaborating Center, Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Campus, Petah Tiqva 49100, Israel. ilanit@dlylaw.co.il
authors.forename: Yariv
authors.initials: Y
authors.lastname: Yogev
authors.forename: Avi
authors.initials: A
authors.lastname: Ben-Haroush
authors.forename: Rony
authors.initials: R
authors.lastname: Chen
authors.forename: Hagit
authors.initials: H
authors.lastname: Glickman
authors.forename: Boris
authors.initials: B
authors.lastname: Kaplan
authors.forename: Moshe
authors.initials: M
authors.lastname: Hod
mesh_terms: D000328:Adult; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000379:methods*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D016640:Diabetes, Gestational / Q000628:therapy; D015232:Dinoprostone / Q000008:administration & dosage; D005260:Female; D005865:Gestational Age; D006801:Humans; D007751:Labor, Induced; D016015:Logistic Models; D016104:Oligohydramnios / Q000453:epidemiology; D010298:Parity; D011247:Pregnancy; D011254:Pregnancy in Diabetics; D016896:Treatment Outcome
chemical_list: D015232:Dinoprostone