Risk factors for shoulder dystocia during labor in women with diabetes mellitus


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Abstract

Objective: Identify risk factors for shoulder dystocia in labor in women with diabetes mellitus (DM) and assess the contribution of the identified determinants of adverse obstetric and perinatal outcomes to this complication. Materials and methods: This retrospective cohort study was conducted at the D. O. Ott Research Institute for OG&P. Pregnant women with different types of DM delivered over 10 years (2008-2017, n=3261) were divided into comparison groups. There were patients with T1DM receiving continuous subcutaneous insulin infusion (CSII) (n=60), patients with T1DM on multiple daily insulin injections (MDII) (n=446), patients with T2DM on diet (n=95), T2DM on insulin therapy (n=134), gestational DM on diet (n=1652), gestational DM on insulin therapy (n=735), and control group (n=139). The odds ratios (OR) were calculated to determine the risk and assess the contribution of determinants to the development of shoulder dystocia. Statistical analysis was performed using SPSS v 23.0 software. Results: One of the most significant risk factors for shoulder dystocia in labor was fetal weight. In the presence of DM, the minimum fetal weight at which the risk of shoulder dystocia was significantly increased was 4250 g; at fetal weight greater than 4750 g, the odds ratio for shoulder dystocia increased 5-fold (OR 4.86; 95% CI 1.32- 14.5). Other significant risk factors were maternal age (>30 years), prepregnancy body mass index (>30 kg/m2), glycated hemoglobin level in the first trimester (>6.5%), and gestational weight gain over 15 kg. At the same time, a history of DM was not found to be a predictor of fetal dystocia in women with DM. Conclusion: Individual evaluation of the identified risk factors will optimize a rational pregnancy management algorithm and the choice of mode and tim ing of delivery, thereby reducing the incidence of shoulder dystocia in patients with DM.

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About the authors

Roman V. Kapustin

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology; St. Petersburg State University

Email: kapustinroman@gmail.com
MD, PhD, Academic Secretary; Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Medical Faculty

Ekaterina V. Kopteeva

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology

MD, Junior Researcher, Department of Obstetrics, Division of Maternal-Fetal Medicine

Elena N. Alekseenkova

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology

Email: ealekseva@gmail.com
MD, Junior Researcher, Department of Obstetrics, Division of Maternal-Fetal Medicine

Elizaveta M. Tsybuk

St. Petersburg State University

Email: elizavetatcybuk@gmail.com
student, Faculty of Medicine

Olga N. Arzhanova

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology; St. Petersburg State University

Email: arjanova_olga@mail.ru
Dr. Med. Sci., Principal Researcher at the Department of Obstetrics, Division of Maternal-Fetal Medicine; Professor at the Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine

Igor Yu. Kogan

D.O. Ott Research Institute for Obstetrics, Gynecology and Reproductology; St. Petersburg State University

Email: ikogan@mail.ru
Dr. Med. Sci., Director; Professor at the Department of Obstetrics, Gynecology and Reproduction, Faculty of Medicine

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