妊娠期糖尿病终止妊娠时机的探讨

目的探讨妊娠期糖尿病的最佳终止妊娠时机，改善母儿结局，提高阴道分娩率。方法回顾性分析我院2012年符合中国卫生部颁布的妊娠期糖尿病诊断标准的孕妇286例，在孕期予饮食营养运动指导后血糖控制满意，空腹血糖（FPG）均在3．3～5．1mmol／L，餐后2h在6．7mmol／L以下排除各种妊娠合并症、并发症，在充分知情同意下，随机分组选择终止妊娠时间，观察组（孕39^＋1～40周）170例，对照组（孕38^＋1～39周）116例，行宫颈评分，予缩宫素、米索前列醇、普贝生三种引产方法引产，比较阴道分娩率、因胎儿窘迫、头盆因素、社会因素、引产失败而行手术的剖宫产率。结果观察组（孕39^＋1～40周）比对照组（孕38^1～39周）阴道分娩率有所提高，因引产失败、社会因素而剖宫产的比率有所下降，差异有统计学意义，在胎儿窘迫、头盆因素而剖宫产方面较无明显差异。结论对于在孕期予饮食营养运动指导后血糖控制满意，无妊娠合并症、并发症的无产兆孕妇，孕39^＋1～40周是妊娠期糖尿病的最佳终止妊娠时机，可提高阴道分娩率。

STUDY ON PREGNANCY TERMINATING TIME IN PATIENTS WITH GESTATIONAL DIABETES MELLITUS

Objective To explore the pregnancy terminating time in patients with gestational diabetes mellitus, and to improve maternal and fetal outcomes and increase vaginal delivery rates. Methods Review and analysis of pregnant women in author＇s hospital during 2012 were performed retrospectively, 286 cases in total were diagnosed according to diagnostic criteria of gestational diabetes mellitus issued by Chinese Ministry of Health. For pregnant women with satisfactory control of blood sugar level directed through alimentary control or kinesiatrics during pregnancy, the average level of fasting blood glucose （FPG） was 3.3- 5. 1mmol/L, the FPG level less than 6. 7 mmol/L for 2 hours after meal. Pregnant women, pregnancy complications excluded, were randomly grouped and pregnancy terminating time were selected, being fully -informed and that of self-determination, 170 cases （gestation 39^＋1 -40 weeks） in experimental group and 116 cases in control group （gestation 38^＋1 -39 weeks） included. Based on Cervical Scoring and induction treatment with oxytocin, misoprostol, parturifaeient action respectively, comparative study was con- ducted between vaginal delivery rates and cesarean delivery rates for induction failure, social factors, fetal distress and cephalopelvie disproportion. Results The results showed that experimental group （gestation 39^＋1 -40 weeks） had higher vaginal birth rates than control group （gestation 38^＋1 -39 weeks）, with statistical difference lowering cesarean delivery rates for induction failure and social factors, but with no statistical difference increasing cesarean delivery rates for fetal distress and eephalopelvic disproportion. Conclusions It can be concluded that, for pregnant women with no signs of labor, noncomplications and satisfactory control of blood sugar level directed through alimentary control or kinesiatrics during pregnancy, gestation age at 39^＋1 -40 weeks is the best pregnancy terminating time with improving chances of vaginal delivery.