الفهرس | Only 14 pages are availabe for public view |
Abstract Diabetes prevalence in Egyptian adults, among the 10 highest national levels in the world. The growth of diabetes is so serious that healthcare systems will soon be struggling to cope with the costs of treating the predicted level of complications. Diabetes mellitus with pregnancy prevalence varies worldwide ,and is a major cause of perinatal morbidity and mortality, as well as maternal morbidity. Identification and adequate management of diabetes mellitus reduced perinatal morbidity in infants of women with diabetes. “screening, diagnosis, and treatment of gestational diabetes is costeffective”. Slightly more than half of the live births in the five-year period before the 2014 in Egypt were by caesarean section. This study was designed to study the impact of diabetes mellitus on cesarean section rate primarily. And to study the impact of diabetes mellitus on pregnancy outcomes (preeclampsia, macrosomia , preterm and shoulder dystocia). IADPSG criteria for diagnosing diabetes with pregnancy was used, RBS of 160 mg% was used as cutoff level to include women in group B. The present study included 650 pregnant women in labor, divided to two groups. group A (normoglycemic) including 553 women, and group B (women with impaired glucose levels) including 97 women. The incidence of impaired glucose level in our study reaches 15%. The cesarean section rates in group A was 41.3%, while in group B it was 67% . The total incidence of cesarean deliveries in the study was 45.5% (296 cesarean deliveries). The incidence of CS in group B was similar in both hospitals where study was performed, while Mansoura New General Hospital has a higher CS rate among group A participants. Fetal macrosomia , fetal distress , and failure to progress ,where the leading causes to perform CS in group B participants .incidence of macrosomia in group (B) showed a( n=30) as 31%. Shoulder dystocia in group (B) showed a (n=2) as 2%. According to WHO crieteria for diagnosis DM with pregnancy with 200mg% as a cutoff level leads to decrease number of patients to 62 cases, (97 patients with IADPSG Criteria). Cesarean section rate is 71% in those patients. A major factor contributing to increase cesarean rate is Malpractice litigation related to fetal injury during spontaneous or operative vaginal delivery, so the frequency of forceps and vacuum deliveries has decreased. Most obstetricians prefer to perform cesarean section as a simple way, to avoid trial of labor and its complications. By using IADPSG criteria for diagnosis of hyper glycemia with pregnancy, more complications could be predicted and prevented. An optimum screening ,diagnosis ,and management protocols for diabetes complicating pregnancies is a must ,to control its complications , decrease the likelihood of cesarean section, limit unnecessary costs ,and to improve maternal and society health condition. |