EVALUATION OF DIFFERENT DELIVERY TACTICS IN PATIENTS WITH GESTATIONAL DIABETES ACCORDING TO THE TWO LOCAL PROTOCOLS

Objective. To evaluate clinical outcomes of labour induction in patients with gestational diabetes (GD) regarding the choice different delivery tactics.

Design and methods. The cohort retrospective study including 443 patients with gestational diabetes had given birth during 2014 and 2015 was conducted on the base of Federal North-West Medical Research Centre due to two different local clinical protocols, respectively. The patients were subdivided into two groups: first group — 251 women with GD (2014), second group — 192 (2015). Labour outcomes of the labour outcomes were estimated in each group.

Results. Complications of labour such as dysthyroidism (p=1) and fetal distress (p=0,236) did not significantly differ between groups after induction of labour: 7% (3 of 43) and 9,3% (4 of 43) — in the first, 7,7% (2 of 26) and 11,5% (3 of 26) — in the second group, respectively. Clinically important is the fact that uterine inertia was twofold lower in the second group comparing to the first one: 7% (3 of 43) and 15,4% (4 of 26), respectively, that ii however not statistically significant for this size of data selection (p=1). The rate of diabetic embryopathy (p=0,341), macrosomia (p=0,364), urgent caesarean section (p=0,694) did not significantly differ between groups.

Conclusion. Lengthening of expectant management in patients with GD in the absence of other indications for earlier delivery has led to the decrease in labour complications. Single standard tactic probably cannot be regarded as an appropriate choice for labour at 38-39 weeks for all patients with GD, such tactic should be used in the risk group for antenatal fetal death.

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