ABSTRACT
The purpose of this study was to test the hypothesis that the incidence of shoulder
dystocia could be reduced in insulin-requiring diabetic women by elective induction
of labor at 38 to 39 weeks of gestation. A prospective study protocol in which labor
was induced at 38 to 39 weeks of gestation in insulin-requiring diabetic women was
executed between January 1, 1990, and July 31, 1994 (n=96). The outcome was compared
to the results of a previous protocol (years 1983 to 1989) in which the pregnancies
were allowed to progress to spontaneous labor, unless fetal health became compromised
(n=164). The incidence of shoulder dystocia in patients in whom labor was electively
induced at 38 to 39 weeks of gestation was 1.4% as compared to 10.2% in patients who
delivered beyond 40 weeks' gestation (p <0.05). No increase in cesarean section rate
was demonstrated. We conclude that elective induction of labor is suggested for insulin-requiring
diabetic women in order to reduce the incidence of shoulder dystocia.
Keywords
Shoulder dystocia - gestational diabetes mellitus - pregnancy complications - labor
