B. Tandu-Umba).Based primarily on the 75-g oral glucose tolerance test (OGTT), adverse outcomes associated with gestational diabetes mellitus (GDM) have been reported even with levels of maternal glycemia lower than those diagnostic of diabetes, thus leading to lowered criteria for the diagnosis of GDM [1]. However, no consensus has been reached regarding the thresholds of blood glucose levels that should be considered when treating pregnant women with nondiabetic hyperglycemias.An observational cohort study was conducted to determine the fasting plasma glucose (FPG) level that identifies pregnant women at particular risk of GDM-related outcomes without performing the OGTT. The study was approved by the Institutional Review Board of the Faculty of Medicine, University of Kinshasa, Democratic Republic of Congo.Women with a singleton pregnancy at 24-32 weeks of gestation who had provided informed consent to participate were enrolled in the study, which was conducted from June 1, 2011, through December 31, 2011, in the prenatal care unit of University Clinics, Kinshasa. Prepregnancy diabetic women and those delivering before 37 weeks were excluded. No OGTTs were performed. FPG was assayed using One Touch Profile Meters (Lifescan, Johnson & Johnson, High Wycombe, UK) and women recording an FPG level of 95 mg/dL or greater were managed to achieve a fasting blood glucose level of less than 95 mg/dL, as previously reported for GDM in this setting [2]. Risk factors for GDM were recorded and the outcomes studied were pre-eclampsia; polyhydramnios; cesarean delivery; macrosomia (≥3800 g from local studies); low birth weight (LBW) (b 2250 g in accordance with local standards); stillbirth; congenital malformation; Apgar score of less than 7 at 1 minute; and clinical and chemical hypoglycemia (b 45 g/dL) in neonates. Heel-stick sampling was used for neonatal blood glucose monitoring 1 hour after birth.In total, 108 women and their neonates were recruited to the study. In 18 (16.7%) women, a history of diabetes was reported among first or second degree family members. The mean values for maternal age and gestational age at recruitment and at confinement were 30.49 ± 5.17 years, 28.31 ±2.84 weeks, and 37.95 ± 1.54 weeks, respectively.The mean parity and gravidity were 2.2± 1.50 and 2.78 ±1.68, respectively. Mean maternal body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) was 25.94 ±4.48. FPG ranged from 60 mg/dL up to 199 mg/dL, with a mean of 109.98 ± 32.41 mg/dL. Eight (7.4%) women qualified as diabetic (≥126 mg/dL). Mean birth weight and neonatal glycemia were 3018.80± 619.09 g and 65.51 ± 20.07 mg/dL, respectively.Five adverse outcomes were prominent (Table 1): cesarean delivery (n=49, 45.4%); pre-eclampsia (n= 24, 22.2%); low birth weight (n= 22, 20.4%); neonatal chemical hypoglycemia (n=19, 17.6%); and macrosomia (n= 14, 13.0%). Among LBW infants, 14 (63.6%) were born to women with pre-eclampsia. No clinical neonatal hypoglycemia was observed.The FPG levels at which adverse outcom...

Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. Logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8; CI 1.2 - 39.7), and somewhat birth weight (OR 2.1 but CI containing 1). Risk for cesarean section was increased in association with induction of labor in cases of high maternal weight (OR 10.3, CI 16.0 - 67.0), and somewhat of high birth weight (OR 2.3, but CI containing 1). Fetal distress was associated only with maternal weight (OR 15.7, CI 1.3 - 187.8), and neonatal distress only with Bishop score (OR 10.9, CI 1.1 - 108.0). Conclusion Induction of labor in our setting in order to get vaginal delivery is affected of a high risk of adverse outcomes such as failure of induction, cesarean delivery, fetal and neonatal distress. This risk is significantly influenced by maternal weight, birth weight and Bishop score. Lack of worse outcomes between the first and the subsequent attempts to induce labor can be regarded as a reason to try induction even in the presence of unfavorable cervix.

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