100.

Management of pregnancy and labour for

patients with Gestational Diabetes Mellitus
Povilas Varnelis1, Gabija Didžiokaitė1, 2, dr. Jelena Volochovič 1, 2
1 - Vilnius University, Faculty of Medicine;
2 - Vilnius University Hospital Sanatros Clinics, Department of Obstetrics and Gynecology

Background Newborns’ weight was classified into three groups Relationship between newborn
using World Health Organization (WHO) percentile weight (according to WHO) and
Gestational diabetes mellitus is recommendations (small<11, 10>normal>90, delivery mode was strong in all
defined as glucose intolerance 89<large).5 population (p=0,001, ϕ=0,246)
“diagnosed in the second or third Comparisons of abstracted data were performed: and on the week 40 (p=0,003,
trimester of pregnancy that was not ϕ=0,266) making it more likely
clearly overt diabetes prior to • Continuous variables with t-tests;
that high-weight-newborn will
gestation”. 1 Constant uncontrolled • Categorical values with Fischer exact tests and be delivered by CD.
maternal hyperglycemia can result Pearson Chi-Square test;
in large-for-gestational-age (LAG) • By convention, significance was set at two-tailed p-
fetus (newborn), greater risk of value <0.05.
Caesarean delivery (CD) and other
complications. 3
There are no evidence based Results
recommendations on obstetric Demographics
tactics when to induce labour to Parašyti 39 Fišeris
Among different gestational weeks cohorts could be
lower the risk of CD. Padaryti tris diagramas
compared by mean newborn weight (MNW) at week
Nupiešti indikacijų diagramas
It is important to find out the best 39 and 40.
tactics for patients with GDM since GA,
VD NW, g p CD NW. g p
the prevalence of this state is weeks
rapidly increasing across the world. 37 4 2855±670,149 0,855 1 N N
38 10 3390±726,850 0,2* 4 3270±937,479 0,354
39 19 3405,53±343,887 0,2* 13 3547,69±624,425 0,005
Objective
40 106 3627,55±410,034 0,01 32 3857,5±527,330 0,2*
The goal of this preliminary study 41 8 3676,25±450,204 0,2* 4 3730±464,327 0,125
is to identify optimal gestational
Total 147 3564±457,977 0,009 54 3690,74±648,048 0,001
age (GA) for induction of labour
(IOL) at term among patients with Table 1. Type of delivery and mean newborn weight at 37-41 gestational
GDM according to newborn weeks. (*lower bound of true significance).
weight (NW), rate of CD and Discussion
indications for CD at different GA. Most CDs were performed at week 39.
37 80.0% 20.0%
Methods 38 71.4% 28.6%
Figure 1. This retrospective cohort study 39 59.4% 40.6%
utilized a convenience sample. Data
identification and patient selection criteria are 40 76.8% 23.2%
detailed below. 41 66.7% 33.3%
Identification
[n=263] Figure 2. The disposition of VD CD CD – Caesarian delivery;
induced delivery.
VD – Vaginal delivery.
• Electronic Medical Records of patients
from a Vilnius university Santaros Cohorts’ newborn weight was classified into three
clinics‘ registry meeting the following
criteria were selected: group according to WHO recommendations.
• Admitted between June 01, 2014 –
October 23, 2018 VD CD
GA,
• Nulliparous Low Normal Large Low Normal Large
weeks
weight weight weight weight weight weight
• Singelton delivery
37 2 1 1 1 0 0
• IOL between 37-41 gestational weeks
38 3 3 4 1 2 1
• Gestational diabetes mellitus 39 3 15 1 3 5 5
Exclusion 40 10 84 12 2 19 11
41 0 8 0 0 4 0
[-] 62 18 111 18 7 30 17
Total
• (5) Congenital anomalies of fetus (12,2%) (75,6%) (12,2%) (13%) (55,5%) (31,5%)
• (16) Pre-gestational diabetes Table 2. The disposition of induced delivery. CD – Caesarian delivery;
• (2) Chronic hypertension VD – Vaginal delivery.
• (13) Preeclampsia
• (26) Prelabour rupture of membranes References
Vaginal delivery vs. C-section
Analysis
MNW between cohorts on the weeks 39
[n=201] (p=0,014), 40 (p=0,029) and in total (p=0,002)
• The study population was dichotomized differed significantly.
into two groups according to delivery No significant association was discovered
mode:
• Vaginal delivery (includes vacuum
between delivery mode and low newborn
extraction and forceps(17)) weight in all population (p=0,457) and between
• Caesarean delivery different gestational weeks.