الفهرس 
EpidemiologyOnly 14 pages are availabe for public view
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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.