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Trial of labor after cesarean delivery for pregnancies complicated by gestational diabetes mellitus
Author(s) -
Ganer Herman Hadas,
Kogan Zviya,
Bar Jacob,
Kovo Michal
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12164
Subject(s) - medicine , gestational diabetes , obstetrics , vaginal delivery , cesarean delivery , logistic regression , pregnancy , gynecology , randomized controlled trial , gestational age , gestation , surgery , genetics , biology
Objective To assess rates of, and factors associated with, trial of labor and vaginal delivery among pregnancies complicated by both gestational diabetes ( GDM ) and a previous cesarean delivery. Methods In a retrospective study of singleton deliveries at a university hospital in Israel between 2009 and 2015, women with one previous cesarean delivery and GDM were matched to those without GDM by past cesarean delivery indication: non‐favorable (non‐progressive labor or failed induction) or favorable (all other indications). Computerized files were reviewed, and maternal, obstetric, and neonatal outcomes were compared. Results In total, 109 women with GDM were matched to 109 control women. Trial of labor was attempted by 55 (50.5%) women in the control group and 11 (10.1%) in the GDM group ( P< 0.001). Overall, 42 (38.5%) control women and 5 (4.6%) women with GDM delivered vaginally ( P< 0.001). Multivariable logistic regression identified lack of GDM as the most significant factor associated with trial of vaginal delivery, followed by a prior vaginal delivery. Among women attempting a trial of labor, past vaginal delivery, but not GDM status, was associated with successful vaginal delivery. Conclusion GDM significantly diminished the likelihood of a trial of vaginal delivery after cesarean delivery and its subsequent success.