Women with gestational diabetes mellitus in the ACHOIS trial: Risk factors for shoulder dystocia
Women with gestational diabetes mellitus in the ACHOIS trial: Risk factors for shoulder dystocia
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DOI：
10.1111/j.1479-828x.2006.00676.x
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发表时间：
2007-02-01
影响因子：
1.7
通讯作者：
Willson, Kristyn
中科院分区：
文献类型：
--
作者：
Athukorala, Chaturica;Crowther, Caroline A.;Willson, Kristyn
背景：妊娠糖尿病（GDM）与巨大儿和肩难产的风险增加有关。然而，并不是所有的妇女与GDM和巨大胎儿肩难产Aims：以确定肩难产的危险因素在妊娠期糖尿病妇女招募到ACHOIS trial.Methods的常规护理组的妇女的数据：二次分析，从妇女参加ACHOIS试验收集的数据进行。使用Fisher精确检验进行双变量分析。变量被发现与肩难产和以前确定的危险因素显着相关，被用作多变量分析的解释变量。产妇空腹高血糖的严重程度与肩难产的风险呈正相关，空腹口服葡萄糖耐量试验增加1 mmol导致相对风险（RR）为2.09（95% CI 1.03-4.25）。肩难产发生率在阴道手术分娩中更高（RR 9.58，95% CI 3.70-24.81，P < 0.001）。巨大儿和大于胎龄儿更易发生肩难产（RR分别为6.27，95% CI 2.33-16.88，P < 0.001和4.57，95% CI 1.74-12.01，P < 0.005）。巨大胎儿是唯一的变量，以保持其意义在所有的多变量analysis.Conclusions：巨大胎儿是最强的独立危险因素肩难产。需要有效的预防策略。
Background: Gestational diabetes mellitus (GDM) is associated with increased risk of fetal macrosomia and shoulder dystocia. However, not all women with GDM and fetal macrosomia have shoulder dystocia.Aims: To identify the risk factors for shoulder dystocia in women with gestational diabetes using data from women recruited into the routine care group of the ACHOIS trial.Methods: A secondary analysis was performed on data collected from women enrolled in the ACHOIS trial. Bivariate analyses were performed using the Fisher exact test. Variables found to be significantly associated with shoulder dystocia and previously identified risk factors were used as explanatory variables in multivariate analyses.Results: A positive relationship was found between the severity of maternal fasting hyperglycaemia and the risk of shoulder dystocia, with a 1 mmol increase in fasting oral glucose-tolerance test leading to a relative risk (RR) of 2.09 (95% CI 1.03-4.25). Shoulder dystocia occurred more often in births requiring operative vaginal delivery (RR 9.58, 95% CI 3.70-24.81, P < 0.001). Macrosomic and large-for-gestational-age infants were more likely to have births complicated by shoulder dystocia (RR 6.27, 95% CI 2.33-16.88, P < 0.001 and RR 4.57, 95% CI 1.74-12.01, P < 0.005, respectively). Fetal macrosomia was the only variable to maintain its significance in all multivariate analyses.Conclusions: Fetal macrosomia is the strongest independent risk factor for shoulder dystocia. Effective preventative strategies are needed.