Frequency Of Cesarean Section Research Articles

Ratio of Cesarean Sections to Total Procedures as a Marker of District Hospital Trauma Capacity

There are few established metrics to define surgical capacity in resource-limited settings. Previous work hypothesizes that the relative frequency of cesarean sections (CS) at a hospital, expressed as a proportion of total operative procedures (%CS), may serve as a proxy measure of surgical capacity. We attempted to evaluate this hypothesis as it specifically relates to hospital capacity for emergency interventions for injury. We conducted a WHO survey of emergency surgical capacity at 40 Rwandan district hospitals in November 2010 and extracted annual operative volume for 2010 from the Ministry of Health centralized statistical system. We dichotomized the 40 hospitals into low and high %CS groups below and above the median proportion of CS performed. We compared low and high %CS groups across self-reported capabilities related to facility characteristics, trauma supplies, procedural capacity, and surgical training using bivariate χ(2) statistics with significance indicated at p ≤ 0.05. We evaluated herniorrhaphy proportion of total procedures (%Hernia) as a representative general surgery procedure in the same manner. High %CS hospitals were less likely to report capability related to blood banking (p = 0.05), amputation (p = 0.04), closed fracture repair (p = 0.04), inhalational anesthesia (p = 0.05), and chest tube insertion (p = 0.05). Availability of reliable electricity was the only measure that showed statistical significance with the %Hernia measure (p = 0.02). Cesarean section proportion shows some utility as a marker for district hospital injury-care capacity in resource-limited settings.

Pregnancy outcome in inflammatory bowel disease: prospective European case-control ECCO-EpiCom study, 2003-2006

Inflammatory bowel disease (IBD) frequently affects women during their reproductive years. Pregnancy outcome in women with IBD is well described, particularly in retrospective studies. To evaluate the pregnancy outcome in patients with IBD in a prospective European multicentre case-control study. Inflammatory bowel disease pregnant women from 12 European countries were enrolled between January 2003 and December 2006 and matched (1:1) to non-IBD pregnant controls by age at conception and number of previous pregnancies. Data on pregnancy and newborn outcome, disease activity and therapy were prospectively collected every third month using a standard questionnaire. Logistic regression analysis with odds ratio was used for statistical analyses. P value<0.05 was considered significant. A total of 332 pregnant women with IBD were included: 145 with Crohn's disease (CD) and 187 with ulcerative colitis (UC). Median age (range) at conception was 31 years (15-40) in CD and 31 (19-42) in UC patients. No statistically significant differences in frequency of abortions, preterm deliveries, caesarean sections, congenital abnormalities and birth weight were observed comparing CD and UC women with their non-IBD controls. In CD, older age was associated with congenital abnormalities and preterm delivery; smoking increased the risk of preterm delivery. For UC, older age and active disease were associated with low birth weight; while older age and combination therapy were risk factors for preterm delivery. In this prospective case-control study, women with either Crohn's disease or ulcerative colitis have a similar pregnancy outcome when compared with a population of non-inflammatory bowel disease pregnant women.

Difficult intubation in pregnancy

This review focuses on difficult intubation in pregnant patients, particularly during the late pregnancy when physiological, patho-physiological and psychological factors may cause or aggravate difficulties with providing sufficient oxygenation and securing the airway. It is intended to highlight the methodological approach to the difficult airway in this particular patient population and to draw relevant principles in dealing with this problem. There are strong indications for improvement in the outcome of airway management in pregnant patients; however, this is obscured by the growing frequency of caesarean sections and connected to this by more tracheal intubations. Various new airway devices have been suggested as alternative techniques for laryngoscopic intubation if the latter becomes difficult or failed. A scenario-oriented approach to the problem of difficult intubation in pregnant patients leads to the recognition of the unpredicted difficult or failed intubation as the main concern. The appropriate means to cope with this rare but life-threatening complication lies in a gradual employment of principles beginning with preferential application of regional anaesthesia techniques, followed by proceeding according to locally adapted simple and comprehensive failed intubation algorithms, design of a suitable difficult airway cart that contains only a few but well chosen items and by implementation of a continuous and mandatory training program to which all personnel are subjected to participate in regular intervals.

Glycemic control and pregnancy outcomes in women with type 2 diabetes from Poland. The impact of pregnancy planning and a comparison with type 1 diabetes subjects

The number of pregnancies complicated by type 2 diabetes mellitus (T2DM) is growing; however, their clinical characteristics remain incomplete. We aimed to assess clinical characteristics, glycemic control, and selected pregnancy outcomes in pregestational T2DM from Poland and to compare them with those of T1DM. We analyzed 415 consecutive singleton pregnancies; among them, there were 70 women with T2DM and 345 with T1DM. As compared to T1DM patients, women with T2DM were older (mean age 33.1 years vs. 27.8, respectively), heavier before pregnancy (mean BMI 30.8 kg/m² vs. 23.9), and had a shorter duration of diabetes (mean 3.3 years vs. 11.4); ( P<0.0001 for all comparisons). The gestational age at the first visit was higher in T2DM (mean 11.4 weeks vs. 8.6; P=0.0004). Nevertheless, they had better glycemic control in the first trimester (mean HbA1c 6.2% vs. 7.0; P=0.003); in subsequent months, the differences in HbA1c were no longer significant. T2DM women gained less weight during pregnancy (mean 9.9 kgs vs. 14.1; P<0.0001). The proportion of miscarriages (10.0 vs. 7.3%; P=0.32), preterm deliveries (12.7 vs. 17.8%; P=0.32), combined infant deaths, and congenital malformations were similar in both groups (9.5 vs. 8.8%; P=0.4) as was the frequency of caesarean sections (58.7 vs. 64.1%; P=0.30). Macrosomic babies were more than twice less frequent in T2DM and the difference reached borderline significance (7.9 vs. 17.5%, P=0.07). Pregnancy planning in T2DM had a significant impact on HbA1c in the first trimester (5.7 vs. 6.4% in the planning vs. the not planning group, P=0.02); the difference was not significant in the second and third trimester. T2DM women had better glycemic control in the first trimester than T1DM subjects and gained less weight during pregnancy. This could have been the reason for the slightly lower number of macrosomic babies but did not affect other outcomes. In T2DM, pregnancy planning had a beneficial glycemic effect in the first trimester.

Frecuencia de la cesárea en Andalucía: relación con factores sociales, clínicos y de los servicios sanitarios (2007-2009)

Increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. The objective was to describe the use of caesarean section in the Andalusian region in Spain by exploring the role of social, clinical, and health services variables. A cross-sectional study was carried out using vital statistics. It involves all births occurred in Andalusia during the period of 2007-2009. The dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. Multivariate logistic regressions were used. In the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. The multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (OR=19.36). Regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. Cádiz was the province with the highest OR for caesarean section (comparison between Cádiz and Almería: OR=1,21) where the ratio between births in public and private hospitals was 3.7. The frequency of caesarean section was 34% higher in women with third level education than those with no education. Labour complication is the most influential variable for caesarean section. Caesarean birth rate is above the accepted standards for all social classes and increases with educational level. Inter-provincial differences reflect different patterns with regard to the use of private medicine.

Clinical analysis of 70 cases of repeat cesarean section

Objective To investigate the cesarean section and repeat cesarean section on maternal and perinatal outcome.Methods 150 cases of repeat cesarean section cesarean section according to the number of cesarean section were divided into repeat cesarean section group(Group A)70 cases and primary cesarean section group (Group B)80 cases.The clinical data,pregnant women in general,intrapartum and postpartum complications,perinatal outcome in two groups were analyzed.Results The pregnancy with complicatiom in group A were significantly higher than that in group B(χ2=3.752,P＜0.05);The incidence of pelvic adhesions 50%in group A were significantly higher than that 23.8%in group B(χ2=7.852,P＜0.01);The breast-feeding in group A after 6 months,12months were lower than that in group B(χ2=1.6657;3.756,all P＜0.05).The incidence of pregnancy complications associated with the frequency of cesarean section(r=0.548,P＜0.05).Conclusion Repeat cesarean section does not affect the perinatal outcome,the incidence of pregnancy complications related to the number of cesarean section. Key words: Cesarean section; Repeat; Pregnancy outcomes; Sex life; Breast-feeding

Effect of pre-pregnancy body mass index and weight gain during pregnancy on the risk of emergency cesarean section in nullipara

We attempted to examine the effects of delivery via emergency cesarean section in nullipara, presenting with increase in body weight during pregnancy and pre-pregnant body mass index. A total of 1,024 nullipara with singleton pregnancy who experienced labor pain after 37 gestational weeks at St.Vincent's Hospital of Catholic University of Korea during 1 January 2004 to 31 March 2010 were enrolled in this study. Study patients were divided into four groups based on pre-gestational BMI, two groups based on weight gain more than 18 kg during pregnancy and three groups based on weight gain according to the guidelines of IOM (Institute of Medicine). Univariate and multivariate analysis were performed. On univariate analysis, the frequency of emergency cesarean section was increased both in pre-pregnant overweight women and women with excess weight gain during pregnancy. On multivariate analysis, however, increase in body weight during pregnancy according to IOM guidelines did not independently affect the frequency of emergency cesarean section. If the degree of increase in body weight during pregnancy was divided based on a definite numeric value of 18 kg, the frequency of cesarean section was significantly increased. For successful spontaneous delivery, the nullipara should become pregnant when the pre-gestational BMI is maintained at an appropriate level. We also propose that women should not gain more than 18 kg until delivery in all pre-BMI groups.

Study of Frequency and Indications of Cesarean Section in a Tertiary Care Hospital of Garhwal-Uttarakhand, India

Objectives of the study were to ascertain the frequency of cesarean sections (CSs) and to study various indications of CSs.

Antibiotikaprofylakse ved keisersnitt - retningslinjer ved norske fødeavdelinger

The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations. All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department's written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS). 38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward. Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.

The effect of introduction of misoprostol for induction of labour on pregnancy in gravidas with pre-eclampsia

Misoprostol has revolutionized labour induction since the early 1990’s, because it is inexpensive and very effective. Eclampsia is common unless the pregnancy can be terminated by induction or by caesarean section. This study was done to determine the impact of Misoprostol used for induction of labour, on the outcome in patients with pre-eclampsia (PE) at the University of the West Indies Kingston Jamaica. This was a retrospective analysis of pre-eclamptic women who were managed before and after the introduction of misoprostol into routine usage for induction of labour. We compared 793 women (controls) in the pre misoprostol era (1986-1991) with 709 in the misoprostol era (1993-1998). Outcome variables were the frequency of mild and severe PE, eclampsia, misoprostol and syntocinon inductions, foetal complications and use of caesarean section (CS). Analysis of frequency of eclampsia, neonatal admissions and CS, during the misoprostol years, was also done to eliminate other confounding variables because of the influence of each era. Logistic regression was used to determine the impact of all variables. In comparison to controls, patients induced in the misoprostol years had a greater incidence of severe PE (p < 0.05), neonatal admissions (p = 0.007), foetal distress (p < 0.05); a higher CS rate (p < 0.05); but fewer oxytocin inductions (p < 0.05). However, sub group analysis of the misoprostol years alone, showed a reduction in the incidence of CS, eclampsia, and neonatal admissions in women who were induced with misoprostol (p < 0.05). Logistic regression revealed a lower odds of CS delivery (OR 0.867, 95% confidence interval .02, .37) using misoprostol. These findings suggest that in patients with PE, induction of labor with Misoprostol had a beneficial effect on pregnancy outcome with a decreased incidence of CS, eclampsia and neonatal admissions, but it has not had a significant impact on the main problems in these patients between the two eras as other factors may be important in the management of these patients independent of misoprostol induction.

Obesity in pregnancy

Obesity, the most common metabolic disorder, concerns, among others, women of reproductive age and, when it occurs before or during pregnancy, constitutes a major risk factor for both maternal and fetal complications. The complications of obesity in a prospective mother include subfertility, miscarriage, thrombo-embolism, hypertensive disorders, metabolic syndrome, preterm delivery and higher frequency of cesarean section. Fetal complications include intrauterine death, congenital anomalies and macrosomia. Moreover, the complications of maternal obesity do not only involve the fetus; they also extend beyond fetal life into childhood and adulthood. The mother's diet during pregnancy creates a metabolic environment that affects fetal growth and may result in later development of metabolic syndrome and cardiovascular disease, a phenomenon known as "developmental origin of adult disease". Since the expectant mother is usually more motivated to accept lifestyle modifications, pregnancy is a period during which obesity can be more effectively managed. The control of body weight during this period is of paramount importance for pregnancy outcome as well as the health status of the mother and the neonate.

The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations

ObjectiveTo investigate the effect of advanced maternal age (AMA) separately in nulliparous and multiparous women on obstetric and perinatal outcomes in singleton gestations.Study designA historical cohort study on data from 6,619 singleton pregnancies between 2004 and May 2007 was performed. AMA was defined as 35 years and older. Obstetric and perinatal outcomes in AMA versus women younger than 35 years (non-AMA) were compared for both nulli- and multiparae with Student’s t-test and Chi-square test in univariate analysis. Multiple logistic regression analysis was performed to examine the independent effect of AMA.ResultsOut of 6,619 singleton pregnancies, the frequency of nulliparity was 42.7 and 33.4% of the parturients were of AMA. Among nulliparous women, AMA was significantly associated with a higher frequency of caesarean section both before labour (OR 2.26 with 95% CI 1.74–2.94), in labour (OR 1.44 with 95% CI 1.07–1.93), and more instrumental vaginal deliveries (ORs 1.49 with 95% CI 1.13–1.96). Among multiparous women, AMA was only significantly associated with a higher caesarean section rate before labour (ORs 1.42, 95% CI 1.19–1.69). There were no significant differences between the two age groups in the prevalence of other adverse obstetric outcomes and adverse perinatal outcomes.ConclusionsOperative delivery is increased in AMA, including caesarean sections, as well as instrumental vaginal deliveries in nulliparous women. In multiparous women, however, only the rate of caesarean section before labour was increased. AMA had no significant effect on other adverse obstetric and perinatal outcomes irrespective of parity.

Secular trends in gestational age and birthweight in twins

In recent decades, the overall rate of preterm births has increased. The aim of the present study was to examine whether this trend is also seen for multiple gestations. More specifically, we examined if there has been a decrease in gestational age for live born monozygotic (MZ) and dizygotic (DZ) twins and if there has been a simultaneous change in birthweight. The contributions of fertility treatments and Caesarean sections were taken into consideration. All analyses were carried out in two large European twin cohorts. Cross-sectional study of 6310 live born twin pairs, born between 1964-2007, from the Belgian East Flanders Prospective Twin Survey and 14,712 twin pairs, born between 1990-2006, from the Netherlands Twin Register. Multiple regression analyses were performed with gestational age as outcome variable, and multilevel analysis with birthweight as outcome variable. All analyses were performed with and without adjustment for zygosity, parity, maternal age, mode of conception and delivery and, for the analyses of birthweight, gestational age. Gestational age decreased in a linear fashion from 1964 to 2007 with a decrease of 0.25 days per year in a similar way for MZ and DZ twins. Changes in birthweight depended on gestational age: up to 32 weeks, birthweight decreased and after 32 weeks birthweight increased. The frequency of infertility treatment and Caesarean sections, primiparity and advanced maternal age increased over the years, but none of these factors influenced the secular trends in gestational age and birthweight. The decrease in gestational age and change in birthweight in twins are sources of concern, especially for very preterm twins, for whom birthweight decreased. For twins born after 32 weeks, an increase in birthweight was observed and this is very likely the explanation for the decrease in gestational age.

Electroacupuncture for cervical ripening prior to labor induction: a randomized clinical trial

The present study was aimed to compare the effects of the use of electroacupuncture and misoprostol in inducing labor in patients with Bishop score < 7 and to observe the characteristics of labor in both methods. As much as 67 pregnant women with Bishop score < 7, single cephalic presentation with gestational age confirmed by first-trimester ultrasound, reactive cardiotocography, and amniotic fluid volume and estimated fetal weight within the respective normal ranges for gestational age were selected. They were randomized into 2 groups: electroacupuncture (AC) or misoprostol (M). There were no significant differences regarding age, gestational age, fetal weight, parity, Bishop score, or indication for induction. Labor was the main outcome, which was obtained in both groups without significant difference regarding frequency (p = 0.07) and time of induction (p = 0.29). Absence of obstetric complication, higher duration of labor (p = 0.036), and tendency to a higher satisfaction of the patients (p = 0.046) were observed among patients of group AC. Higher frequency of cesarean sections (p = 0.014) and obstetric complications (9.3%) were observed among patients of group M. Our results showed that electroacupuncture can be used to obtain cervical ripening, with similar results as compared with misoprostol, with a significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications.

Prenatal Diagnosis of Morbidly Adherent Placenta with 2D Ultrasonography, 3D Color Power Doppler and Magnetic Resonance Imaging

Abstract The incidence of placenta accreta/percreta should rise steadily over the next century as the frequency of cesarean sections and advanced maternal age, both independent risk factors, increases. Patients who are at risk should be identified. The diagnosis of placenta previa accreta/percreta is possible by using gray-scale sonography, conventional color Doppler imaging and MRI through studying the relation of placenta to the uterine wall and nearby pelvic structures. The potentially new modality of 3D and 3D color power Doppler ultrasound has it's value as a tool to achieve significantly increased diagnostic accuracy in the prediction of massive hemorrhage by assessing the extent, location and quantification of abnormal uteroplacental neovascularization. Hence, 3D ultrasound has the potential for providing additional information over conventional 2D ultrasound studies in the diagnosis of placenta previa percreta. The diagnosis and anticipation of the problem achieve the best results for the obstetrician and the patient.

Proportion of litters of purebred dogs born by caesarean section

To describe the frequency of caesarean sections in a large sample of pedigree dogs in the UK. Data on the numbers of litters born in the previous 10 years were available from a cross-sectional study of dogs belonging to breed club members (2004 Kennel Club/BSAVA Scientific Committee Purebred Dog Health Survey). In this survey 151 breeds were represented with data for households that had reported on at least 10 litters (range 10-14,15): this represented 13,141 bitches which had whelped 22,005 litters. The frequency of caesarean sections was estimated as the percentage of litters that were reported to be born by caesarean section (caesarean rates) and are reported by breed. The dogs were categorised into brachycephalic, mesocephalic and dolicocephalic breeds. The 10 breeds with the highest caesarean rates were the Boston terrier, bulldog, French bulldog, mastiff, Scottish terrier, miniature bull terrier, German wirehaired pointer, Clumber spaniel, Pekingese and Dandie Dinmont terrier. In the Boston terrier, bulldog and French bulldog, the rate was > 80%. These data provide evidence for the need to monitor caesarean rates in certain breeds of dog.

Good pregnancy outcome despite intrahepatic cholestasis

Objective. Pregnant women complaining of itching are screened for intrahepatic cholestasis (ICP) by laboratory tests in primary healthcare. Cases of ICP are referred to specialist care. In Finland, ICP occurs in 1% of pregnancies. The aim was to study the outcome of deliveries. Design. Retrospective study of ICP pregnancies. Data were collected from the hospital discharge register, patient records, and the labour register. Setting. The region of Tampere University Hospital in Finland. Subjects. Altogether 687 ICP cases from 1969 to 1988 and two controls for each. Main outcome measures. ICP patients were compared with controls in terms of mother's age, pregnancy multiplicity, weeks of gestation at delivery, frequency of induction and Caesarean section, length of ward period, child's weight, Apgar scores, and stillbirth. Results. For ICP patients, the risk for hospital stay of 10 days or more was eightfold (OR 8.41), for gestational weeks less than 37 at delivery sevenfold (OR 7.02), for induction threefold (OR 3.26), for baby's low weight at birth almost twofold (OR 1.86), and for Caesarean section one and a half fold (OR 1.47). The possibility of the incidence of multiple pregnancy was two and a half fold (OR 2.49, 95%). ICP was not associated with mother's age, the baby's risk of stillbirth, or low Apgar scores. Conclusion. ICP mothers are found and taken care of appropriately, and thus ICP is only a minor risk for mothers and their children.

Association Between Vitamin D Deficiency and Primary Cesarean Section

Rickets (rachitic pelvis) was a common cause of death in childbirth in industrialized nations at the turn of the 20th century and associated with a steep rise in cesarean section rates. The addition of vitamin D to milk caused the virtual disappearance of rickets, but recent reports suggest that vitamin D deficiency is now widespread in industrialized nations. In 2 previous studies, a high incidence of vitamin D deficiency was found in pregnant and lactating women. Another study reported that 50% of mothers and 65% of newborns infants were severely vitamin D deficient (25-hydroxyvitamin D [25(OH)D: <30 nmol/L]) at the time of birth despite drinking vitamin D fortified milk and taking a prenatal vitamin D supplement. It is possible that deficiency of this vitamin may play a role in the nearly 50% increase in primary cesarean sections in the last decade. This study investigated the association between serum concentrations of maternal vitamin D (serum 25(OH)D) at birth and the frequency of primary cesarean section among 253 women enrolled at an urban teaching hospital. Demographic and medical data were obtained from maternal medical records. Maternal serum 25(OH)D was measured within 72 hours of delivery. Serum 25(OH)D was a proxy for vitamin D status. Maternal vitamin D deficiency was defined as serum 25(OH)D less than 37.5 nmol/L (15 ng/mL). Multivariable logistic regression analysis was used to adjust the data for several variables, including race, age, education level, insurance status, and alcohol use. Of the 253 study subjects, 43 (17%) had a primary cesarean section. The frequency of cesarean section and levels of serum 25(OH)D had an inverse association. In unadjusted analysis, more than twice as many women with serum 25(OH)D less than 37.5 nmol/L had a primary cesarean section compared to those with 25(OH)D 37.5 nmol/L or greater (P = 0.012). Multivariate logistic regression analysis showed that a primary cesarean section in women with vitamin D deficiency was nearly 4 times more likely compared to women without deficiency (adjusted OR, 3.84; 95% CI, 1.71-8.62). These findings show a clear association between vitamin D deficiency and increased likelihood of primary cesarean section and suggest the need for a randomized trial to determine whether additional vitamin supplementation could reduce the cesarean section rate.

Maternal and neonatal outcomes following diabetes in pregnancy in Far North Queensland, Australia

Diabetes in pregnancy (DIP) is increasing and is associated with a number of adverse consequences for both the mother and the child. To compare local maternal and neonatal outcomes with state and national data. Chart audit of all DIP delivered during 2004 at a regional teaching hospital and compare outcomes with national benchmark, Queensland and national Indigenous data. The local DIP frequency was 6.7%. The local compared to benchmark and state data demonstrated a higher frequency of Indigenous mothers (43.6% vs 6.8% vs 5.5%), caesarean sections (50.7% vs 26% vs 32.0%), hypoglycaemia (40.7% vs 19.5% vs 2.7%) and respiratory distress (16.6% vs 4.5% vs 2.3%) in infants, fewer normal birthweights (64.8% vs 82.6% vs 80.4%) and full-term deliveries. More local mothers compared to benchmark had type 2 diabetes mellitus (T2DM) (15.4% vs 8.7%) but fewer used insulin (31.0% vs 46.6%); compared to state data, fewer women had gestational diabetes (79.5% vs 91.2%), however, insulin use was higher (22.8%). Furthermore, Aborigines had fewer pregnancies compared to Torres Strait Islanders (3.0 vs 5.0) and less insulin use (21.9% vs 59.3%) (P = 0.008-0.024). In contrast, non-Indigenous versus Indigenous women showed fewer pregnancies, less T2DM (7.8% vs 23.7%), better glycaemic control, longer babies, more full-term deliveries and less severe neonatal hypoglycaemia. Comparing local and national Indigenous data, local showed poorer outcomes, however, only 11.8% had diabetes or hypertension nationally. The local cohort had poorer outcomes probably reflecting a more disadvantaged. Few differences were found between local Indigenous groups.

Perinatal Outcomes in Pregnancies Managed with Antenatal Insulin Glargine

We compared perinatal outcomes in pregnancies in which insulin glargine was used in the management of patients with pregnancies in which standard insulin therapy was used at a single institution. A retrospective analysis of 114 pregnant patients with diabetes (pregestational or gestational) managed at a single center between January 2004 and August 2006 was undertaken. Sixty-five patients managed with insulin glargine were compared with 49 patients managed with neutral protamine Hagedorn (NPH) insulin. Both groups were also treated with short-acting insulin (either regular, lispro, or aspart insulin). Maternal age, parity, prepregnancy weight, body mass index, duration of diabetes, hemoglobin A (1C) (at entry and final recorded) and gestational age at entry were similar for each group (glargine and NPH). Thirty patients had gestational diabetes (18 glargine and 12 NPH); there were no differences in numbers of patients in higher-order White's classification between the two groups. Cesarean section for obstetric reasons included labor abnormalities, malpresentation, fetal distress, and suspected macrosomia. There were no differences in gestational age at delivery, birth weight, preeclampsia, or frequency of cesarean section (total or for obstetric reasons). The frequency of shoulder dystocia was higher in the NPH group. Regarding neonatal outcomes, gestational age at delivery, birth weight, Apgar scores, admission to the neonatal intensive care unit, respiratory distress syndrome, hypoglycemia, and congenital anomalies were similar between the two groups. From this retrospective analysis, no adverse maternal or neonatal effects were seen from maternal administration of insulin glargine. A larger multicenter study is needed to confirm these findings. This preliminary report suggests that use of insulin glargine during pregnancy can be considered if maternal metabolic control is suboptimal using the standard split-mix regimen.