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Melamed N, Avnon T, Barrett J, Fox N, Rebarber A, Shah BR, Halperin I, Retnakaran R, Berger H, Kingdom J, Hiersch L. Gestational diabetes in twin pregnancies-a pathology requiring treatment or a benign physiological adaptation? Am J Obstet Gynecol 2024; 231:92-104.e4. [PMID: 38218511 DOI: 10.1016/j.ajog.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
There is level-1 evidence that screening for and treating gestational diabetes in singleton pregnancies reduce maternal and neonatal morbidity. However, similar data for gestational diabetes in twin pregnancies are currently lacking. Consequently, the current approach for the diagnosis and management of gestational diabetes in twin pregnancies is based on the same diagnostic criteria and glycemic targets used in singleton pregnancies. However, twin pregnancies have unique physiological characteristics, and many of the typical gestational diabetes-related complications are less relevant for twin pregnancies. These differences raise the question of whether the greater increase in insulin resistance observed in twin pregnancies (which is often diagnosed as diet-treated gestational diabetes) should be considered physiological and potentially beneficial in which case alternative criteria should be used for the diagnosis of gestational diabetes in twin pregnancies. In this review, we summarize the most up-to-date evidence on the epidemiology, pathophysiology, and clinical consequences of gestational diabetes in twin pregnancies and review the available data on twin-specific screening and diagnostic criteria for gestational diabetes. Although twin pregnancies are associated with a higher incidence of diet-treated gestational diabetes, diet-treated gestational diabetes in twin pregnancies is less likely to be associated with adverse outcomes and accelerated fetal growth than in singleton pregnancies and may reduce the risk for intrauterine growth restriction. In addition, there is currently no evidence that treatment of diet-treated gestational diabetes in twin pregnancies improves outcomes, whereas preliminary data suggest that strict glycemic control in such cases might increase the risk for intrauterine growth restriction. Overall, these findings provide support to the hypothesis that the greater transient increase in insulin resistance observed in twin pregnancies is merely a physiological exaggeration of the normal increase in insulin resistance observed in singleton pregnancies (that is meant to support 2 fetuses) rather than a pathology that requires treatment. These data illustrate the need to develop twin-specific screening and diagnostic criteria for gestational diabetes to avoid overdiagnosis of gestational diabetes and to reduce the risks associated with overtreatment of diet-treated gestational diabetes in twin pregnancies. Although data on twin-specific screening and diagnostic criteria are presently scarce, preliminary data suggest that the optimal screening and diagnostic criteria in twin pregnancies are higher than those currently used in singleton pregnancies.
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Affiliation(s)
- Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Ontario, Canada.
| | - Tomer Avnon
- Lis Maternity Hospital, Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nathan Fox
- Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
| | - Andrei Rebarber
- Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Ilana Halperin
- Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St Michael's Hospital, Toronto, Ontario, Canada
| | - John Kingdom
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liran Hiersch
- Lis Maternity Hospital, Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Reischer T, Prossinger S, Catic A, Healy E, Göbl C, Yerlikaya-Schatten G. Factors Affecting Mode of Birth in Women With Preexisting Diabetes and Gestational Diabetes: A Retrospective Cohort at a Tertiary Referral Center. J Diabetes Res 2024; 2024:5561761. [PMID: 38883259 PMCID: PMC11178421 DOI: 10.1155/2024/5561761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/25/2024] [Accepted: 05/11/2024] [Indexed: 06/18/2024] Open
Abstract
Women with preexisting diabetes and gestational diabetes mellitus (GDM) are at higher risk for adverse maternal and neonatal outcomes. However, there is no consensus on a uniform approach regarding mode of birth (MOB) for all forms of diabetes. The aim of the study is to compare MOB in women with preexisting diabetes and GDM and possible factors influencing it. A retrospective cohort study of women with GDM and preexisting diabetes between 2015 and 2021 at a tertiary referral center was conducted. One thousand three hundred eighty-five singleton pregnancies were included. One thousand twenty-two (74.4%) women had a vaginal birth (VB) and 351 (25.6%) a caesarean section. Preexisting diabetes was significantly associated with caesarean section compared to GDM (OR 2.43). Five hundred fifty-one (40.1%) women underwent induction of labor, and 122 (22.1%) women had a secondary caesarean after IOL. Women induced due to spontaneous rupture of membrane (SROM) achieved the highest rate of VB at 93%. The lowest rates of VB occurred if indication for induction was for preeclampsia or hypertension. IOL was significantly less successful in preexisting diabetes with a VB achieved in 56.4% for type 1 diabetes and 52.6% of type 2 diabetes compared to GDM (78.2% in GDM; 81.2% in IGDM; OR 3.25, 95% CI 1.70-6.19, p < 0.001). The rate of VB was higher who were induced preterm compared to women with term IOL (n = 240 (81.9%) vs. n = 199 (73.2%); p < 0.05). Parity, previous VB and SROM favored VB after IOL, whereas preexisting diabetes, hypertension, and IOL after 40 + 0 weeks are independent risk factors for caesarean delivery.
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Affiliation(s)
- Theresa Reischer
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Sina Prossinger
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Anja Catic
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Eibhlin Healy
- Fetal Medicine Unit Liverpool Women's Hospital, Liverpool, UK
| | - Christian Göbl
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
| | - Gülen Yerlikaya-Schatten
- Department of Gynaecology and Obstetrics Division of Feto-Maternal Medicine Medical University of Vienna, Vienna, Austria
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3
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Ducarme G, Planche L, Lbakhar M. Predictive Factors for Successful Cervical Ripening among Women with Gestational Diabetes Mellitus at Term: A Prospective Study. J Clin Med 2023; 13:139. [PMID: 38202146 PMCID: PMC10779893 DOI: 10.3390/jcm13010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/14/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The purpose of this prospective cohort study is to identify the predictive factors for vaginal delivery among women (n = 146) who underwent cervical ripening using a dinoprostone insert (PG) alone (13.7%), cervical ripening balloon (CRB) alone (52.7%), oral misoprostol (M) alone (4.1%), or repeated methods (R, 29.5%) for gestational diabetes mellitus (GDM) at term, and to analyze maternal and neonatal morbidity outcomes according to the method for cervical ripening. After cervical ripening, vaginal delivery occurred in 84.2% (n = 123) and was similar among groups (90.0% after PG, 83.1% after CRB, 83.3% after M, and 83.7% after R; p = 0.89). After a multivariable logistic regression analysis adjusted for potential confounders, the internal cervical os being open before cervical ripening was a predictor of vaginal delivery (adjusted odds ratio (OR) of 4.38, 95% confidence index (CI) of 1.62-13.3, p = 0.03), and previous cesarean delivery was a predictor of cesarean delivery (aOR of 7.67, 95% CI of 2.49-24.00, p < 0.01). Birthweight was also significantly associated with cesarean delivery (aOR of 1.15, 95% CI of 1.03-1.31, p = 0.02). The rates of maternal and neonatal morbidity outcomes were 10.9% (n = 16) and 19.9% (n = 29), respectively, and did not differ according to the mode of delivery and to the method used for cervical ripening. Identifying these specific high-risk women (previous cesarean delivery and internal cervical os being closed before cervical ripening) for cesarean delivery among women who underwent cervical ripening for GDM at term is important and practical for all physicians to make a decision in partnership with women.
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Affiliation(s)
- Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
| | - Lucie Planche
- Clinical Research Center, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
| | - Mounia Lbakhar
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France;
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Luo R, Wen W, Corsi DJ, Fell DB, Taljaard M, Wen SW, Walker MC. Comparison of adverse maternal and perinatal outcomes between induction and expectant management among women with gestational diabetes mellitus at term pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:509. [PMID: 37438706 DOI: 10.1186/s12884-023-05779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Induction at 38-40 weeks of gestation has been broadly suggested for women with gestational diabetes mellitus (GDM), yet its benefits and risks remain unclear. This study aimed to systematically review and meta-analyze existing evidence on the effect of induction at term gestation among women with GDM. METHODS We searched MEDLINE, EMBASE, Cochrane Libraries, and Web of Science from inception to June 2021. We included randomized controlled trials (RCTs) and observational studies comparing induction with expectant management among GDM term pregnancies. Primary outcomes included caesarean section (CS) and macrosomia. All screening and extraction were conducted independently and in duplicates. Meta-analyses with random-effects models were conducted to generate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the Mantel-Haenszel method. Methodological quality was assessed independently by two reviewers using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies. RESULTS Of the 4,791 citations, 11 studies were included (3 RCTs and 8 observational studies). Compared to expectant management, GDM women with induction had a significantly lower odds for macrosomia (RCTs 0.49 [0.30-0.81]); observational studies 0.64 [0.54-0.77]), but not for CS (RCTs 0.95 [0.64-1.43]); observational studies 1.03 [0.79-1.34]). Induction was associated with a lower odds of severe perineal lacerations in observational studies (0.59 [0.39-0.88]). No significant difference was observed for other maternal or neonatal morbidities, or perinatal mortality between groups. CONCLUSIONS For GDM women, induction may reduce the risk of macrosomia and severe perineal lacerations compared to expectant management. Further rigorous studies with large sample sizes are warranted to better inform clinical implications.
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Affiliation(s)
- Rong Luo
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Wendy Wen
- McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, Canada
| | - Daniel J Corsi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
| | - Mark C Walker
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Canada.
- Department of Obstetrics, Gynecology & Newborn Care, The Ottawa Hospital, Ottawa, Canada.
- International and Global Health Office, University of Ottawa, Ottawa, Canada.
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Swift EM, Gunnarsdottir J, Zoega H, Bjarnadottir RI, Steingrimsdottir T, Einarsdottir K. Trends in labor induction indications: A 20-year population-based study. Acta Obstet Gynecol Scand 2022; 101:1422-1430. [PMID: 36114700 PMCID: PMC9812102 DOI: 10.1111/aogs.14447] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Use of labor induction has increased rapidly in most middle- and high-income countries over the past decade. The reasons for the stark rise in labor induction are largely unknown. We aimed to assess the extent to which the rising rate of labor induction is explained by changes in rates of underlying indications over time. MATERIAL AND METHODS The study was based on nationwide data from the Icelandic Medical Birth Register on 85 620 singleton births from 1997 to 2018. The rate of labor induction and indications for induction was calculated for all singleton births in 1997-2018. Change over time was expressed as relative risk (RR), using Poisson regression with 95% confidence intervals (CI) adjusted for maternal characteristics and indications for labor induction. RESULTS The crude rate of labor induction rose from 12.5% in 1997-2001 to 23.9% in 2014-2018 (crude RR = 1.91, 95% CI 1.81-2.01). While adjusting for maternal characteristics had little impact, adjusting additionally for labor induction indications lowered the RR to 1.43 (95% CI 1.35-1.51). Induction was increasingly indicated from 1997-2001 to 2014-2018 by gestational diabetes (2.4%-16.5%), hypertensive disorders (7.0%-11.1%), prolonged pregnancy (16.2%-23.7%), concerns for maternal wellbeing (3.2%-6.9%) and maternal age (0.5%-1.2%). No indication was registered for 9.2% of inductions in 2014-2018 compared with 16.3% in 1997-2001. CONCLUSIONS Our results show that the increase in labor induction over the study period is largely explained by an increase in various underlying conditions indicating labor induction. However, indications for 9.2% of labor inductions remain unexplained and warrant further investigation.
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Affiliation(s)
- Emma M. Swift
- Faculty of Nursing and MidwiferyUniversity of IcelandReykjavikIceland,Reykjavik Birth CenterReykjavikIceland
| | - Johanna Gunnarsdottir
- Faculty of Medicine, Center of Public Health SciencesUniversity of IcelandReykjavikIceland,Department of Obstetrics and GynecologyLandspitali ‐ The National University Hospital of IcelandReykjavikIceland,Faculty of MedicineUniversity of IcelandReykjavikIceland
| | - Helga Zoega
- Faculty of Medicine, Center of Public Health SciencesUniversity of IcelandReykjavikIceland,Faculty of Medicine and Health, School of Population HealthUniversity of New South WalesSydneyAustralia
| | - Ragnheidur I. Bjarnadottir
- Department of Obstetrics and GynecologyLandspitali ‐ The National University Hospital of IcelandReykjavikIceland,Faculty of MedicineUniversity of IcelandReykjavikIceland
| | - Thora Steingrimsdottir
- Department of Obstetrics and GynecologyLandspitali ‐ The National University Hospital of IcelandReykjavikIceland,Faculty of MedicineUniversity of IcelandReykjavikIceland
| | - Kristjana Einarsdottir
- Faculty of Medicine, Center of Public Health SciencesUniversity of IcelandReykjavikIceland
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Seimon RV, Natasha N, Schneuer FJ, Pereira G, Mackie A, Ross GP, Sweeting AN, Seeho SKM, Hocking SL. Maternal and neonatal outcomes of women with gestational diabetes and without specific medical conditions: an Australian population‐based study comparing induction of labor with expectant management. Aust N Z J Obstet Gynaecol 2022; 62:525-535. [PMID: 35347699 PMCID: PMC9545300 DOI: 10.1111/ajo.13505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Radhika V. Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders Faculty of Medicine and Health Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
| | - Nassar Natasha
- The Boden Initiative, Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
| | - Francisco J. Schneuer
- The Boden Initiative, Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
| | - Gavin Pereira
- School of Public Health Curtin University Perth Western AustraliaAustralia
- Telethon Kids Institute Perth Western AustraliaAustralia
- Centre for Fertility and Health (CeFH) Norwegian Institute of Public Health Oslo Norway
| | - Adam Mackie
- Women and Babies Royal Prince Alfred Hospital Sydney New South Wales Australia
- Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School The University of Sydney Sydney New South Wales Australia
| | - Glynis P. Ross
- Discipline of Obstetrics, Gynaecology and Neonatology Central Clinical School The University of Sydney Sydney New South Wales Australia
- Discipline of Medicine Central Clinical School The University of Sydney Sydney New South Wales Australia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
| | - Arianne N. Sweeting
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders Faculty of Medicine and Health Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
- Discipline of Medicine Central Clinical School The University of Sydney Sydney New South Wales Australia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Sean K. M. Seeho
- Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Women and Babies Research Kolling InstituteRoyal North Shore HospitalThe University of Sydney Sydney New South Wales Australia
- Specialty of Obstetrics, Gynaecology and Neonatology Northern Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Samantha L. Hocking
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders Faculty of Medicine and Health Charles Perkins Centre The University of Sydney Sydney New South WalesAustralia
- Department of Endocrinology Royal Prince Alfred Hospital Sydney New South Wales Australia
- Central Clinical School Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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7
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Sun J, Chai S, Zhao X, Yuan N, Du J, Liu Y, Li Z, Zhang X. Predictive Value of First-Trimester Glycosylated Hemoglobin Levels in Gestational Diabetes Mellitus: A Chinese Population Cohort Study. J Diabetes Res 2021; 2021:5537110. [PMID: 33928166 PMCID: PMC8053049 DOI: 10.1155/2021/5537110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022] Open
Abstract
This study was aimed at exploring the predictive value of first-trimester glycosylated hemoglobin (HbA1c) levels in the diagnosis of gestational diabetes mellitus (GDM). A total of 744 pregnant women registered at the Peking University International Hospital between March 2017 and March 2019 were included in this study. Data on personal characteristics and biochemical indicators of the pregnant women were collected during the first trimester. The International Association of Diabetes and Pregnancy Study Groups has adopted specific diagnostic criteria as the gold standard for the diagnosis of GDM. Receiver operating characteristic (ROC) curve statistics were used to assess the predictive value of first-trimester HbA1c levels in the diagnosis of GDM. HbA1c levels in the first trimester were significantly higher in the GDM group than in the non-GDM group (5.23% ± 0.29% vs. 5.06 ± 0.28%, P < 0.05). The first-trimester HbA1c level was an independent risk factor for gestational diabetes. The area under the ROC curve (AUC) of HbA1c for GDM was 0.655 (95% confidence interval 0.620-0.689, P < 0.001). The positive likelihood ratio was the highest at HbA1c = 5.9%, sensitivity was 2.78, and specificity was 99.83%. There was no statistical difference in AUC between fasting blood glucose and HbA1c (P = 0.407). First-trimester HbA1c levels can be used to predict GDM. The risk of GDM was significantly increased in pregnant women with first-trimester HbA1c levels > 5.9%. There was no statistical difference between first-trimester HbA1c and fasting blood glucose levels in predicting GDM.
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Affiliation(s)
- Jianbin Sun
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Sanbao Chai
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Xin Zhao
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Ning Yuan
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Jing Du
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Yufang Liu
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
| | - Zhi Li
- Department of Obstetrics and Gynecology, Peking University International Hospital, Beijing 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing 102206, China
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8
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Rottenstreich M, Rotem R, Samueloff A, Sela HY, Grisaru-Granovsky S. Trial of labor after cesarean delivery in grand multiparous women: maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2020; 35:2629-2634. [PMID: 32664760 DOI: 10.1080/14767058.2020.1790518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate success rates of vaginal birth after cesarean (VBAC) and maternal and neonatal outcomes associated with trial of labor after cesarean in grand multiparous women. STUDY DESIGN A retrospective computerized data base study was conducted at a single tertiary center, between 2005 and 2019. The study compared the maternal and neonatal outcomes of trial of labor after cesarean delivery in grand multiparous women (parity ≥ 6) as compared to multiparous women (parity: 3-5). Comparison analysis was performed by univariate analysis and followed by adjusted multiple logistic regression models. RESULTS During the study period we identified 2749 and 4294 cases of trial of labor after cesarean in grand multiparous and multiparas, respectively. VBAC was observed in 94.6% of the grand multiparous as compared to 96.5% in the multiparous group, p < .01. The grand multiparous group had a higher rate of postpartum hemorrhage (3 vs. 2.2%, p = .03) and prolonged postpartum hospitalization (1.4 vs. 0.7%, p < .01). The rates of uterine rupture (0.3 vs. 0.2%, p=.50), peripartum hysterectomy (0.1 vs. 0%, p = .33) and adverse neonatal outcomes were comparable between the groups. CONCLUSION Trial of labor after cesarean in grand multiparous women is associated with favorable maternal and neonatal outcomes. Consideration and awareness should be given for the increased risk for postpartum hemorrhage, not associated with uterine rupture.
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Affiliation(s)
- Misgav Rottenstreich
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.,Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Arnon Samueloff
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Hen Y Sela
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Sorina Grisaru-Granovsky
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
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9
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Comparison of the Cook vaginal cervical ripening balloon with prostaglandin E2 insert for induction of labor in late pregnancy. Arch Gynecol Obstet 2020; 302:579-584. [PMID: 32617665 DOI: 10.1007/s00404-020-05597-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare the effectiveness of the Cook vaginal cervical ripening balloon (CCRB) with prostaglandin E2 (PGE2) insert for induction of labor in late pregnancy in primipara. METHODS We evaluated the effectiveness and safety of induction of labor using the improved Bishop score after CCRB or PGE2 administration, total stage of labor, hours until delivery (hours from placement of CCRB or PGE2 insert to parturition and delivery), delivery rate within 24 h, spontaneous delivery rate, successful induction rate, overstimulation syndrome, urgent delivery rate, pain scores, cesarean section rate, and outcomes related to delivery and perinatal morbidity, such as puerperal infection rate, total cost, satisfaction survey, and so on. RESULTS The improved Bishop Score and delivery rate within 24 h in the CCRB group were significantly higher than in the PGE2 group. The total stage of labor and hours until delivery in the CCRB group were significantly shorter than that in the PGE2 group. Rate of overstimulation syndrome and pain scores in the CCRB group were significantly lower than in the PGE2 group. Compared with the PGE2 group, the mean duration of hospitalization in the CCRB group was shorter and the total cost was less. No difference in satisfaction between the PGE2 and CCRB groups was observed. CONCLUSIONS Compared with PGE2, CCRB reduced the total stage of labor, hours until delivery, pain scores, mean length of hospitalization, and total cost. CCRB increased the rate of delivery within 24 h with similar safety and maternal satisfaction compared with PGE2.
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10
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Coates D, Makris A, Catling C, Henry A, Scarf V, Watts N, Fox D, Thirukumar P, Wong V, Russell H, Homer C. A systematic scoping review of clinical indications for induction of labour. PLoS One 2020; 15:e0228196. [PMID: 31995603 PMCID: PMC6988952 DOI: 10.1371/journal.pone.0228196] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS 68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive evidence. CONCLUSIONS While for some indications, IOL is clearly recommended, a number of common indications for IOL do not have strong supporting evidence. Overall, few RCTs have evaluated the various indications for IOL. For conditions where clinical equipoise regarding timing of birth may still exist, such as suspected macrosomia and elevated BMI, researchers and funding agencies should prioritise studies of sufficient power that can provide quality evidence to guide care in these situations.
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Affiliation(s)
- Dominiek Coates
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Angela Makris
- Department of Medicine, Western Sydney University, Sydney, Australia
- Women’s Health Initiative Translational Unit (WHITU), Liverpool Hospital, Liverpool, Australia
| | - Christine Catling
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Amanda Henry
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Women’s and Children’s Health, St George Hospital, Sydney, Australia
- The George Institute for Global Health, UNSW Medicine, Sydney, Australia
| | - Vanessa Scarf
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Nicole Watts
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Deborah Fox
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Purshaiyna Thirukumar
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Vincent Wong
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Research Science, University of New South Wales, Liverpool, Australia
| | - Hamish Russell
- South Western Sydney Local Health District, Sydney, Australia
| | - Caroline Homer
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
- Maternal and Child Health Program, Burnet Institute, Victoria, Australia
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