Features of operative delivery in women with gestational diabetes and obesity

Abstract

DOI: 10.52705/2788-6190-2024-03.2-01
УДК 618.5-089.888.61-618.3:616.12-008:615.225

The objective: to analyze cesarean section in women with gestational diabetes mellitus and obesity and to improve them to prevent complications for the mother and newborn.
Materials and methods. The course of pregnancy, indications for cesarean section, surgical technique, perinatal complications, and the state of the postpartum period for 2020-2024 were analyzed according to the medical documentation of the Municipal non-profit enterprise of the Kharkiv Regional Council «Regional Clinical Hospital». The results of the examination and operative delivery of 110 primiparous pregnant women are presented. They were divided into the following clinical groups: the main group consisted of 32 pregnant women (29.1%) with GDM and obesity, the first comparison group consisted of 30 pregnant women (27.3%) with GDM, the second comparison group consisted of 28 pregnant women (25.4%) with obesity, and 20 pregnant women (18.2%) who did not have extragenital pathology formed the control group. A general clinical examination and ultrasound examination of the fetoplacental complex were performed. The newborn’s condition was assessed using the Apgar score and by measuring the acid-base status of the umbilical cord blood.
Results. When analyzing medical documentation, it was found that the number of pregnant women with obesity almost doubled from 16.5% in 2021 to 31% in 2022, which could be influenced by the beginning of the war, stress, being pregnant in a combat zone, psycho-emotional factors, and eating disorders. The number of patients with GDM also changed towards an increase in frequency from 30.7% in 2021 to 37.8% - in 2023, obesity could play an important role in this process. Based on the cesarean section technique from the clinical protocol of the Ministry of Health of Ukraine «Caesarean section»; and the NICE Guideline «Cesarea section»; proposed to supplement it with some points in women with GDM with obesity. When comparing the results of childbirth, it was determined that in the examined women, the most frequent indications for cesarean section (CS) were macrosomia, fetopathy, weakness of labor activity, ineffective induction of labor activity, and fetal distress. To prevent complications of CS in pregnant women with GDM and obesity, it was proposed to improve the protocol of the operation by finalizing some of its stages, taking into account the features of the existing extragenital pathology.
Conclusions. The increase in extragenital pathology, especially during the war, among which the frequency of endocrine diseases increased, led to a rise in the frequency of operative delivery. Improving the technique of cesarean section in women with obesity and gestational diabetes mellitus will contribute to the reduction of complications in the postoperative period on the part of the
mother, perinatal morbidity, and mortality.