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Poster Session 1

(217) Prediction Model for Intrapartum Cesarean Delivery among Women with Gestational Diabetes Mellitus

Thursday, January 30, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Itamar Gilboa, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

    • Coauthor(s)

  • Daniel Gabbai, MD, MPH

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

  • Emmanuel Attali, MD

    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center
    Tel-Aviv, Tel Aviv, Israel

  • Liran Hiersch, MD

    MFM specialist
    Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University, Israel
    Lis Hospital for Women’s Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • YY

    Yariv Yogev, MD

    Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv University
    Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

  • AL

    Anat Lavie, MD

    Tel Aviv Sourasky Medical Center
    Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

Objective:

To identify risk factors and develop a predictive model for intrapartum cesarean delivery (CD) in women with gestational diabetes mellitus (GDM).

Study Design:

This retrospective cohort study was conducted at a university-affiliated tertiary medical center with approximately 12,000 deliveries annually from 2011-2023. Inclusion criteria included all patients with GDM who had a trial of vaginal delivery. Exclusion criteria included multiple gestations, non-viable fetuses, and elective cesarean delivery. Univariate and multivariate analyses compared characteristics of women delivering vaginally (control group) with those having intrapartum CD (study group). A risk prediction score model was developed.

Results:


  1. Out of 11,817 women, 782 (6.6%) underwent intrapartum CD, while 11,605 (93.4%) delivered vaginally.

  2. Independent risk factors for CD included: maternal age ≥40 years (OR=1.9, 95%CI 1.4-2.6, p< 0.001); pre-gestational BMI >30kg/m² (OR=1.4, 95%CI 1.1-1.8, p=0.003); gestational weight gain >15kg (OR=1.6, 95%CI 1.3-1.9, p< 0.001); maternal height < 1.6m (OR=2.0, 95%CI 1.6-2.4, p< 0.001); nulliparity (OR=4.0, 95%CI 3.2-5.2, p< 0.001); previous cesarean delivery (OR=19, 95%CI 12.8-28.1, p< 0.001); induction of labor (OR=2.7, 95%CI 2.2-3.3, p< 0.001); use of oxytocin (OR=1.6, 95%CI 1.2-2.1, p< 0.001); antibiotics during labor (OR=5.9, 95%CI 4.9-7.2, p< 0.001); preeclampsia (OR=2.7, 95%CI 1.8-3.9, p< 0.001); birthweight ≥3,750g (OR=1.6, 95%CI 1.2-2.0, p< 0.001); and male fetus (OR=1.3, 95%CI 1.1-1.6, p=0.003).

  3. Reduced risk factors for intrapartum CD included previous VBAC (OR=0.05, 95%CI 0.01-0.2, p< 0.001), and epidural analgesia (OR=0.7, 95%CI 0.9-1.5, p=0.005).

  4. The score model demonstrated an AUC of 0.856 (95%CI 0.84-0.87, p< 0.001), with a cutoff score of 9, sensitivity of 82%, and specificity of 76%.



Conclusion:

The predictive model for intrapartum CD in GDM patients aids caregivers in providing informed consultations and identifying high-risk patients for optimal delivery planning.