Perinatal outcomes in gestational diabetes in relation to ethnicity in the Netherlands

BACKGROUND

The influence of ethnicity in women with gestational diabetes in relation to maternal, pregnancy and neonatal outcome is not well defined.

AIM

To compare the perinatal outcome in women with gestational diabetes between different ethnic groups reflecting the multi-ethnic population in the Netherlands.

METHODS

Patients with gestational diabetes (n = 388) who visited the multidisciplinary outpatient clinic for Diabetes Care and Obstetrics of the Sint Franciscus Gasthuis in Rotterdam between 2010 and 2013 were included. Ethnicity was distinguished into six groups: Moroccan (n = 100); Turkish (n = 43); Caucasian (n = 146); Suriname-Creole (n = 23); Suriname-Hindu (n = 32); and Miscellaneous (n = 44).

RESULTS

Caucasians were the largest group with gestational diabetes (37.7%), followed by Moroccans (25.8%). Body mass index before pregnancy was highest in Surinamese-Creole women, followed by Turks and Moroccans (p < 0.001). Gravidity and parity were highest in Moroccans. Gravidity was lowest in Surinamese-Hindus and parity was lowest in Caucasians (p < 0.001). There was also a remarkable, significant difference in the mode of delivery between the ethnicities with the lowest number of normal deliveries in Caucasians and the highest in Moroccans (p = 0.03). Assisted delivery occurred most frequently in Caucasian women, although there was no difference in the frequency of caesarean sections. Birth weight was the only neonatal parameter showing significant differences between the ethnicities, with the highest birth weight for Moroccan children and the lowest for Surinamese children (3542 g vs. 3200; p = 0.001).

CONCLUSION

This study did not show major differences in maternal or neonatal complications, however there are significant disparities in (percentile) birth weight and mode of delivery across the different ethnic groups.

A randomised trial comparing low dose vaginal misoprostol and dinoprostone for labour induction

OBJECTIVE

To compare vaginal misoprostol with dinoprostone for induction of labour.

DESIGN

Randomised multicentre trial.

SETTING

Labour wards of one university hospital and two teaching hospitals.

POPULATION

Six hundred and eighty-one women with indication for labour induction at >or=36 weeks of gestation, singleton pregnancy and no previous ceasarean section.

METHODS

Misoprostol (25 mcg, hospital-prepared capsule) in the posterior vaginal fornix, every four hours, maximum three times daily or dinoprostone gel (1 mg) every four hours. Oxytocin was administered if necessary.

MAIN OUTCOME MEASURES

Primary: 'adverse neonatal outcome' (5-minute Apgar score <7 and/or umbilical cord pH <7.15). Secondary: labour duration, mode of delivery and patient satisfaction.

RESULTS

Three hundred and forty-one women received misoprostol and 340 dinoprostone. The median induction-delivery interval was longer in the misoprostol group compared with the dinoprostone group (25 versus 19 hours, P= 0.008). The caesarean section rate was lower in the misoprostol group: 16.1%versus 21%, but this difference was not statistically significant RR = 0.8 (95% CI 0.6-1.04). 'Adverse neonatal outcome' was found to be similar in both groups: 21% in the misoprostol and 23% in the dinoprostone groups. Significantly fewer neonates were admitted to NICU in the misoprostol group compared with dinoprostone 19%versus 26% (RR = 0.7, 95% CI 0.5-0.98).

CONCLUSIONS

Misoprostol in this dosing regimen is a safe method of labour induction. NICU admission rates were lower in the misoprostol group. No difference could be detected in patient satisfaction between groups.

Intervention Rates after Elective Induction of Labor Compared to Labor with a Spontaneous Onset

INTRODUCTION

Elective induction of labor has become a widely used procedure in obstetrics. A number of studies have shown an increased incidence of operative deliveries. The objective of this study was to evaluate the rate of interventions in our hospital, including operative delivery.

METHODS

A matched cohort study in which labor of 122 electively induced women and 122 women with labor with a spontaneous onset were analyzed retrospectively. These women were matched for parity and gestational age.

RESULTS

Pain relief, fetal scalp blood sampling and operative deliveries were recorded more frequently in the electively induced labor group. Cesarean delivery was found in 15% of women with induced labor, and in 1% of labors with a spontaneous onset (relative risk 18 (95% CI 2.4-132.7)). No differences were found in neonatal outcomes.

CONCLUSIONS

Elective induction of labor leads to increased intervention rates during labor. The rate of cesarean delivery is high, particular in nulliparous women and multiparous women without a previous vaginal birth.

Low dose sulprostone for termination of second and third trimester pregnancies

OBJECTIVE

The purpose of this study is to assess the effectiveness and safety of sulprostone (nalador) for labour induction in the event of foetal death or foetal malformations.

STUDY DESIGN

Retrospective analysis of 284 women with intrauterine foetal death (n=137), or foetal abnormalities (n=147), who underwent labour induction with sulprostone in a continuous dose of 1microg/min intravenously.

RESULTS

All but three women had a successful vaginal delivery. The median induction-expulsion interval was significantly shorter (12h) in the foetal death group compared to the foetal malformation group (25h). Two uterine ruptures were recorded, one in a woman with a uterine anomaly, and one in a woman with a previous caesarean section. There were no other complications. Gestational age had a significant influence on spontaneous expulsion of the placenta: before 24 weeks 55%, and after 24 weeks 82% spontaneous expulsion. For the chance of a neonate born with signs of life, parity was the only significant determinant.

CONCLUSIONS

The use of intravenous sulprostone in a low continuous dose is both effective and safe. In addition, this study does not support former opinions that smoking and advanced maternal age are contraindications.