INTERRUPCIÓN PROGRAMADA EN DIABETES Y EMBARAZO?

extraído de

Review article  Induction of labour indications and timing: A systematic analysis of
clinical guidelines  Dominiek Coates   Women and Birth in press  https://doi.org/10.1016/j.wombi.2019.06.004

EN REFERENCIA A LA DIABETES GESTACIONAL

Las guías son inconsistentes en referencia al momento de interrupción, particularmente cuando no hay ninguna complicación materno fetal.

Mientras algunas guías no consideran causa de interrupción en ausencia de otras indicaciones

• Queensland Health. Gestational diabetes mellitus Australia. Queensland Health; 2017
• Victoria Health. Induction of labour. 2018https://www2.health.vic.gov.au/ hospitals-and-health-services/safer-care-victoria/maternity-ehandbook/in- duction-of-labour

Otras plantean interrupción a las 40

• National Women’s Health. Induction of labour. New Zealand: Auckland District Health Board; 2015

Esperar hasta 40+6

• NICE. Diabetes in pregnancy: management from preconception to the postnatal period. UK: National Institute for Health and Care Excellence; 2015.

Esperar hasta 41

• WHO. WHO recommendations for Induction of labour. World Health Organisation; 2011

Varias  guías  -cuando hay requerimientos de insulina o macrosomía- recomiendan interrupción entre 38 y 39

• King Edward Memorial Hospital. Diabetes in pregnancy. Australia: King Edward Memorial Hospital Obstetrics and Gynaecology. Government of Western Australia North Metropolitan Health Service Women and Newborn Health Service; 2018.
• Queensland Health. Gestational diabetes mellitus Australia. Queensland Health; 2017.
• NICE. Diabetes in pregnancy: management from preconception to the postnatal period. UK: National Institute for Health and Care Excellence; 2015.

Otras guías refieren que la interrupción oportuna depende de una decisión individualizada

• King Edward Memorial Hospital. Diabetes in pregnancy. Australia: King Edward Memorial Hospital Obstetrics and Gynaecology. Government of Western Australia North Metropolitan Health Service Women and Newborn Health Service; 2018.

• ACT Health. Canberra hospital and health services clinical guideline: induction of labour. Canberra: ACT Government; 2018.

• Victoria Health. Induction of labour. 2018https://www2.health.vic.gov.au/ hospitals-and-health-services/safer-care-victoria/maternity-ehandbook/in- duction-of-labour.

DIABETES PREGESTACIONAL

Tres guías- (NICE- ACOG- SOGC)- indican interrupción oportuna , pero solo la primera establece que el momento es entre 37 y 38 semanas o antes según el caso

• NICE. Diabetes in pregnancy: management from preconception to the postnatal period. UK: National Institute for Health and Care Excellence; 2015.

• ACOG. Induction of labor: ACOG practice bulletin. Clinical management guideline for obstretricians-gynecologists. America: The American College of Obstetri-cians and Gynaecologists; 2009.

• SOGC. SOGC clinical practice guideline, induction of labour Canada. Society of Obstetricians and Gynaecologists of Canada; 2013.

Que dice la FIGO sobre diabetes gestacional (extraído de la guía FIGO)

Evaluar el caso a las 38 – 39 semanas

Peso estimado menor de 3800 – adecuado

Antecedente de óbito. Hay enfermedad vascular- mal control- interrumpir inducción, sino se puede continuar

Si el peso es entre 3800 y 4000  inducción

Si es más de 4000 cesárea

• The International Federation of Gynecology and Obstetrics (FIGO)Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and careMoshe Hod and cols International Journal of Gynecology and Obstetrics 131 S3 (2015) S173–S211