Active induction management of labor for diabetic pregnancies at term; mode of delivery and fetal outcome - a single center experience

Objectives: 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. Patients and 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 (R-2 = 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. Conclusion: 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. Condensation: In diabetic pregnancies, induction of labor at term is successful in 82% of patients, but yields higher CS rates compared to uncomplicated pregnancies. (C) 2003 Elsevier Ireland Ltd. All rights reserved.