Leading Cause of Primary Cesarean Delivery in Diabetic Women Is Failed Induction [23D

Abstract

INTRODUCTION: To evaluate mode of delivery in diabetic women compared to non-diabetic pregnant women. METHODS: We conducted a retrospective cohort study of pregnant women at our center from 2013 to 2015. Women with singleton pregnancies, who initiated prenatal care at less than 20 weeks, and who completed their delivery at our institution were included. The diabetic cohort consisted of women with pre-gestational (PGDM) and gestational diabetes (GDM). The primary outcome was mode of delivery: cesarean (CD) or vaginal (VD). The secondary outcome was indication for the primary CD. Continuous variables were compared using student t-test and one-way ANOVA for group comparisons. Categorical variables were analyzed using Chi-square test. A P-value of <.05 was considered statistically significant. RESULTS: Out of 697 women who met the inclusion criteria, 64 (9.2%) had PGDM, 92 (13.2%) had GDM, and 541 (77.6%) were non-diabetic women. Overall, diabetic women were more likely to have a CD compared to non-diabetic women (58% vs. 41%, P=.0001). In both the diabetic and non-diabetic groups, more than half of the cesarean sections were repeat CD. Women with GDM had the highest rate of primary CD (43%). 50% of women in the PGDM group had primary CD for failed induction, as compared to 14% of the GDM women, and 8.3% of the non-diabetic women (P=.0010). CONCLUSION: Failed induction is the leading cause of primary CD in women with pre-gestational diabetes. Studies on induction techniques and assessment in this population are needed.