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Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management.

Abstract：

OBJECTIVE:Our purpose was to assess whether a program of expectant management of uncomplicated pregnancies in mothers with insulin-requiring gestational or pregestational class B reduces the incidence of cesarean birth. STUDY DESIGN:Two hundred women with uncomplicated, insulin-requiring diabetes at 38 weeks' gestation who were compliant with care and whose infants were judged appropriate for gestational age were randomly assigned to (1) active induction of labor within 5 days or (2) expectant management. The expectant management group was monitored with weekly physical examination and twice-weekly nonstress tests and amniotic fluid volume estimation until delivery. RESULTS:Expectant management increased the gestational age at delivery by 1 week. Approximately half (49%) of the mothers in the expectant management group required induction of labor for obstetric indications. The cesarean delivery rate was not significantly different in the expectant management group (31%) from the active induction group (25%). The mean birth weight (3672 +/- 407 gm) and percentage large for gestational age, as defined by birth weight > or = 90th percentile, of infants in the expectantly managed group (23%) was greater than those in the active induction group (3466 +/- 372 gm, p < 0.0001, 10% large for gestational age). This difference persisted after controlling for gestational age and maternal age and body weight (p < 0.01). CONCLUSION:In women with uncomplicated insulin-requiring gestational or class B pregestational diabetes, expectant management of pregnancy after 38 weeks' gestation did not reduce the incidence of cesarean delivery. Moreover, there was an increased prevalence of large-for-gestational-age infants (23% vs 10%) and shoulder dystocia (3% vs 0%). Because of these risks, delivery should be contemplated at 38 weeks and, if not pursued, careful monitoring of fetal growth must be performed.

journal_name

Am J Obstet Gynecol

journal_title

American journal of obstetrics and gynecology

authors

Kjos SL,Henry OA,Montoro M,Buchanan TA,Mestman JH

doi

10.1016/0002-9378(93)90631-r

subject

Has Abstract

pub_date

1993-09-01 00:00:00

pages

611-5

issue

eissn

0002-9378

issn

1097-6868

pii

0002-9378(93)90631-R

journal_volume

169

pub_type

临床试验,杂志文章,随机对照试验

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Insulin-requiring diabetes in pregnancy: a randomized trial of active induction of labor and expectant management.