Gestasyonel Diabetes Mellituslu Hastalarda Acil ve Elektif Sezaryen Doğumların Feto-Maternal Sonuçlarının Karşılaştırılması

Abstract

Amaç: Gestasyonel diyabetes mellituslu (GDM) hastalarda elektif ve acil sezaryen doğumlar arasındaki fetal ve maternal sonuçları karşılaştırmak. Gereç ve Yöntemler: Ocak 2015-Temmuz 2020 tarihleri arasında sezaryen (C/S) yapılan GDM'li hastaların verileri geriye dönük olarak değerlendirildi. Hastalar C/S'nin elektif (n=129) veya acil (n=158) olmasına göre gruplandırıldı. Bulgular: GDM'li hastaların sezaryen oranı (%31.16) ve GDM'li olmayanlara göre daha yüksekti. Acil sezaryen grubunda elektif sezaryen grubuna göre daha fazla anne bakımına sahip hasta vardı (p=0,003). Elektif grupta bir yenidoğan ve acil C/S grubunda altı yenidoğan öldü, ancak yenidoğan ölüm oranları benzerdi (p=0.198). Acil C/S grubunda yara enfeksiyonu, ateş, kan transfüzyonu ihtiyacı ve anne yoğun bakım ünitesi morbiditesi, doğum asfiksisi, solunum morbiditesi ve yenidoğan yoğun bakım gereksinimi fetal morbidite oranları daha yüksekti (p<0.05). Sonuç: Acil C/S, GDM vakalarında daha yüksek oranda olumsuz fetal ve maternal sonuçlara sahiptir. Yeterli anne bakımı ve sezaryen olması muhtemel GDM gebeliklerinin erken tanınması, iyi fetal ve maternal sonuçları destekleyen elektif sezaryen insidansını artırabilir

Keywords

• Diabetes mellitus
• Gebelik
• Komplikasyonlar
• Olumsuz doğum sonuçları
• Cerrahi

Comparison of Feto-Maternal Outcomes Between Emergency and Elective Cesarean Deliveries in Patients with Gestational Diabetes

Abstract

Aim: To compare fetal and maternal outcomes between elective and emergency cesarean sections in patients with gestational diabetes mellitus (GDM). Material and Methods: Data from patients with GDM delivered by cesarean section between January 2015 and July 2020 were retrospectively reviewed. Patients were grouped according to whether the cesarean section was elective (n=129) or emergency (n=158). Results: The cesarean section rate was higher in patients with GDM (31.16%) than in patients without GDM. There were more patients with inadequate maternal care in the emergency cesarean section group than in the elective cesarean section group (p=0.003). One neonate in the elective group and six in the emergency C/S group died, but the rates of neonatal mortality were similar (p=0.198). Maternal morbidity (wound infection, fever, blood transfusion, and maternal intensive care) and fetal morbidity (birth asphyxia, respiratory morbidity, and neonatal intensive care) were higher in the emergency C/S group (p<0.05). Conclusion: Emergency C/S results in a higher rate of adverse fetal and maternal outcomes in GDM. Adequate maternal care and early identification of GDM pregnancies likely to require cesarean section may increase the frequency of elective cesarean sections, favoring good fetal and maternal outcomes.

Keywords

• Diabetes mellitus
• Gestational
• Complications
• Adverse birth outcomes
• Surgery

References

1. 1. Freitag N, Tirado-González I, Barrientos G, Cohen M, Daher S, Goldman-Wohl D, Mincheva-Nilsson L, John CM, Jeschke U, Blois SM. The chimera-type galectin-3 is a positive modulator of trophoblast functions with dysregulated expression in gestational diabetes mellitus. Am J Reprod Immunol. 2020;84:e13311.
2. 2. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;13:e49-e64.
3. 3. Hill DJ. Placental control of metabolic adaptations in the mother for an optimal pregnancy outcome. What goes wrong in gestational diabetes? Placenta. 2018;69:162-168.
4. 4. HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002.
5. 5. Gorgal R, Gonçalves E, Barros M, Namora G, Magalhães A, Rodrigues T, Montenegro N. Gestational diabetes mellitus: A risk factor for non-elective cesarean section. J ObstetGynaecol Res. 2012;38:154-159.
6. 6. Practice Bulletin No. 180: Gestational Diabetes Mellitus. Obstet Gynecol. 2017;130:e17-e37.
7. 7. Vogel JP, Betrán AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, Tunçalp Ö, Mori R, Morisaki N, Ortiz-Panozo E, Hernandez B, Pérez-Cuevas R, Qureshi Z, Gülmezoglu AM, Temmerman M; WHO Multi-Country Survey on Maternal and Newborn Health Research Network. Use of the Robson classification to assess caesarean section trends in 21 countries: A secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3: e260-270.
8. 8. Naz F, Bagum A. Analysis of maternal complications in caesarean section. King Edward Med Uni. 2005;11:239-241.

9. 9. Benzouina S, Boubkraoui Mel-M, Mrabet M, Chahid N, Kharbach A, El-Hassani A, Barkat A. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco. Pan Afr Med J. 2016; 23:197.
10. 10. Darnal N, Dangal G. Maternal and fetal outcome in emergency versus elective Caesarean section. J Nepal Health Res Counc. 2020;18:186-189.
11. 11. Bawah AT, Ngala RA, Alidu H, Seini MM, Wumbee JDK, Yeboah FA. Gestational diabetes mellitus and obstetric outcomes in a Ghanaian community. Pan Afr Med J. 2019;32:94.
12. 12. Blumer I, Hadar E, Hadden DR, Jovanovič L, Mestman JH, Murad MH, Yogev Y. Diabetes and pregnancy: An endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98:4227-4249.
13. 13. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144:768-773.
14. 14. Obut M, Balsak D, Sarsmaz K, Tolunay HE, Varlı EN, Şahin D, Yücel A. Double Foley catheter for labor induction: An alternative method. Int J Gynaecol Obstet. 2021;155(3):496-504.
15. 15. Committee Opinion No 700: Methods for Estimating the Due Date. Obstet Gynecol. 2017 May;129(5):e150-e154.
16. 16. Hoopmann M, Abele H, Wagner N, Wallwiener D, Kagan KO. Performance of 36 different weight estimation formulae in fetuses with macrosomia. Fetal Diagn Ther. 2010;27:204-213.
17. 17. Obstetricians and Gynecologists. Committee on Practice Bulletins-Gynecology. ACOG practice bulletin: Shoulder dystocia. Number 40, November 2002. (Replaces practice pattern number 7, October 1997). Int J Gynaecol Obstet. 2003;80:87-92.
18. 18. Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol. 2012;206:309. e1-7.
19. 19. Blank A, Grave GD, Metzger BE. Effects of gestational diabetes on perinatal morbidity reassessed. Report of the International Workshop on Adverse Perinatal Outcomes of Gestational Diabetes Mellitus, December 3-4, 1992. Diabetes Care. 1995; 18:127-129.
20. 20. Gurunule AA, Warke HS. Maternal and foetal outcome in elective versus emergency caesarean sections. Int J Reprod Contracept Obstet Gynecol. 2017;6:1222-1228.
21. 21. Soren R, Maitra N, Patel PK, Sheth T. Elective versus emergency caesarean section: Maternal complications and neonatal outcomes. IOSR Journal of Nursing and Health Science. 2016; 5:01.
22. 22. Seppänen PM, Sund RT, Uotila JT, Helminen MT, Suominen TM. Maternal and neonatal characteristics in obstetric intensive care unit admissions. Int J ObstetAnesth. 2020; 41:65-70.
23. 23. Heller G, Bauer E, Schill S, Thomas T, Louwen F, Wolff F, Misselwitz B, Schmidt S, Veit C. Decision-to-delivery time and perinatal complications in emergency cesarean section. DtschArztebl Int. 2017;114:589-596.
24. 24. Elvedi-Gasparović V, Klepac-Pulanić T, Peter B. Maternal and fetal outcome in elective versus emergency caesarean section in a developing country. Coll Antropol. 2006;30:113-118.
25. 25. Wetta LA, Szychowski JM, Seals S, Mancuso MS, Biggio JR, Tita AT. Risk factors for uterine atony/postpartum hemorrhage requiring treatment after vaginal delivery. Am J Obstet Gynecol. 2013;209:51. e1-6.
26. 26. Chua SC, Joung SJ, Aziz R. Incidence and risk factors predicting blood transfusion in caesarean section. Aust N Z J Obstet Gynaecol. 2009;49:490-493.
27. 27. McCarthy FP, Rigg L, Cady L, Cullinane F. A new way of looking at Caesarean section births. Aust N Z J Obstet Gynaecol. 2007;47:316-320.
28. 28. ACOG Practice Bulletin No. 205: Vaginal birth after cesarean delivery. Obstet Gynecol. 2019;133:e110-e127.
29. 29. Hauth JC, Clifton RG, Roberts JM, Myatt L, Spong CY, Leveno KJ, Varner MW, Wapner RJ, Thorp JM Jr, Mercer BM, Peaceman AM, Ramin SM, Carpenter MW, Samuels P, Sciscione A, Tolosa JE, Saade G, Sorokin Y, Anderson GD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal insulin resistance and preeclampsia. Am J Obstet Gynecol. 2011;204(4):327.e1-6.