妊娠期糖尿病产妇阴道分娩的安全性

Safety of vaginal delivery in parturients with gestational diabetes mellitus

目的：通过比较妊娠期糖尿病（GDM）产妇与同期正常初产妇的产程、自然分娩率、产后出血率、剖宫产率、肩难产率以及新生儿合并症等指标,探讨GDM产妇阴道分娩的安全性。方法：GDM组初产孕妇112例,正常组初产妇130例,2组分娩前在年龄、体重指数、孕期体重增长等方面均无显著性差异。孕24~28周时通过75g糖耐量试验诊断GDM,行个体化的膳食治疗、运动和胰岛素控制孕妇血糖水平,临产后观察产程指标及新生儿合并症。结果：2组产妇阴道助产率、剖宫产率、胎儿窘迫发生率均无显著性差异（均P〉0.05）。GDM组的肩难产发生率、缩宫素应用率显著高于对照组（P〈0.05,P〈0.01）,总产程时间显著少于正常对照组（P〈0.05）,差异有统计学意义。结论：GDM产妇阴道分娩时应注意防范肩难产的发生,医护人员关注其产程进展,适时应用缩宫素,缩短待产时间,GDM产妇自然分娩时母婴相对安全。

Objective：To explore safety of vaginal delivery in parturients with gestational diabetes mellitus（GDM）by comparing the stages of labor,the rate of natural delivery,postpartum bleeding,cesarean section,shoulder dystocia and neonatal complications.Methods：GDM was diagnosed by OGTT（oral glucose tolerance test）during 24-28 gestational weeks.Blood glucose was controlled by the diet,exercise and/or insulin treatment.We observed the index of labor among 112 GDM primiparas and 130 normal primiparas matched with age,BMI and weight gain.Results：There were no statistical significances in the rates of vaginal midwifery,cesarean section and fetal distress between GDM and control group（all P〉0.05）.The rate of shoulder dystocia and oxytocine use in GDM group was higher than that in the control group（P〈0.05,P〈0.01）,whereas the total labor duration in GDM group was significantly shorter than that in the controls（P〈0.05）.Conclusion：Vaginal delivery is relatively safe for the parturients with GDM,precaution should be taken for the shoulder dystocia.