Outcome of diabetic pregnancy with spontaneous labour after 38 weeks

One hundred and forty-eight patients with well controlled insulin dependent diabetes that were allowed to labour spontaneously from 1981 to 1994 were reviewed. There were 2 perinatal deaths, giving a perinatal mortality rate of 13.5/1000. One hundred and twenty-four patients (84 per cent) had a norm al vaginal delivery, 13 (9 per cent) forceps delivery and 11 (7 per cent) c aesarean section. Twenty-one infants (14 per cent) required admission to a Special Care Baby Unit. One third of infants weighed 4 Kg or more, however there was only 1 case of shoulder dystocia, We compared these results with those of the general hospital population of 1987, The 2 main differences ar e; 1) the Caesarean section rate in labour was higher for this diabetic gro up than for the general hospital population, 7 per cent versus 3.4 per cent , 2) the birth weight was heavier, 33 per cent of infants of the diabetic g roup weighed 4 Kg or more versus 18 per cent of the general hospital popula tion. The other parameters were comparable. We conclude that conservative m anagement of pregnancy in well controlled diabetic women is advantageous, r esulting in a high vaginal delivery rate without an increase in shoulder dy stocia, and a low perinatal morbidity and mortality rate.