OBJECTIVE
To improve maternal and perinatal outcomes in women with gestational diabetes (GD) who have a uterine scar after single cesarean section (CS).
MATERIAL AND METHODS
Our retrospective study included 87 women with a uterine scar after CS and GD diagnosed during this pregnancy. The criteria for inclusion in the study were: spontaneous singleton pregnancy, cephalic presentation of the fetus, uterine scar after one cesarean section, GD, informed consent of the patient to the study. Exclusion criteria were: manifest diabetes mellitus, multiple pregnancy, breech presentation of the fetus. Three groups were identified: the first — patients with spontaneously developed labor (n=28), the second — patients who underwent induction of labor (n=19), and the third — patients who delivered by elective CS (n=40). Also, depending on the outcome of childbirth, the patients were also divided into 2 groups: the first — patients with successful vaginal delivery (VD); n=40 and the second — delivered by CS, including emergency CS (n=47). The following parameters were evaluated: age, pregravidal body mass index (BMI), gestational body weight gain (GBWG), the presence of nondifferentiated connective tissue dysplasia (NDST), the presence of VD in the anamnesis, comorbid complications in this pregnancy, the condition of newborns.
RESULTS
Pregravidal BMI and GBWG in patients delivered through CS (elected and emergency) were statistically significantly higher than in those who had successful VD. NDST, no history of VD, insulin administration and GDM decompensation, complicated pregnancy was also associated with a higher risk of abdominal delivery. While studying perinatal outcomes in groups, it was found that newborns from patients delivered by CS had statistically significantly lower Apgar scores at 5 minutes after birth, had a body weight of more than 4000 g and signs of diabetic fetopathy.
CONCLUSION
The results of the study demonstrate that the choice of the method of delivery for women with GD and uterine scar after CS depends on a comprehensive assessment of such factors as: pregravidal BMI, the presence of NDST, the presence of a history of VD, the type of GD therapy and the duration of insulin therapy, the state of glycemic compensation, as well as comorbid conditions and pregnancy complications. At the same time, in the absence of identified modified risk factors, successful VD is possible.
