Local versus international criteria in predicting gestational diabetes mellitus-related pregnancy outcomes / Philippine Journal of Obstetrics and Gynecology

OBJECTIVE: To evaluate the Philippine Obstetrical and Gynecological Society Clinical Practice Guidelines (POGS-CPG) and the International Association of Diabetes and Pregnancy Study Group (IADPSG) diagnostic criteria for gestational diabetes mellitus (GDM) against pregnancy outcomes.METHODS: This is a randomized controlled trial which enlisted patients attending the Out-patient clinic of our institution. All women included in the study were requested to take a 2-hour 75-gram oral glucose tolerance test (OGTT) between estimated 24th and 28th gestational weeks. In order to diagnose GDM, POGS-CPG consensus required a fasting plasma glucose of >92 mg/dl (5.1 mmol/L) or a 2-hour post-glucose load of >140 mg/dl (7.8 mmol/ml) while lADPSG criteria required 92 mg/dL (5.1 mmol/L) for fasting plasma glucose, 180 mg/dL (10 mmol/L)1-hour post-glucose load, or 153 mg/dL (8.5 mmol/L) 2-hour post-glucose load. Only 1 abnormal value on the OGTT is needed on both criteria to diagnose GDM. Women with diabetes antedating pregnancy were excluded in this study. Based on the 75-g OGTT result, the patients were divided into 4 groups and were followed through delivery. Pregnancy out-comes of the 4 groups were then compared.RESULTS: Among the 389 patients studied, POGS-CPG group had a GDM prevalence rate of 29% whereas the IADPSG group had 16%. Trends have shown that in patients diagnosed with GDM under IADSGP and POGS criteria, no significant differences in the birth-weight status (p=0.156), mode of delivery (p=1.000), indication of cesarean section (p=1.000), and other complications (p=1.000) were noted. The 75 g OGTT values of patients in both groups were not significant predictors of APGAR scores. However, the 1-hour post-glucose load value was shown to be a significantpredictor of birth weight. Yet, the regression models of FBS parameters in predicting APGAR scores and birth weight were still weak.CONCLUSION: There was no significant difference noted between the IADPSG group versus the POGS-CPG group in terms of maternal neonatal outcome.

Comparison on the effect of "hands on" versus " hands off" method on perineal trauma and delivery outcome among nulliparous women / Philippine Journal of Obstetrics and Gynecology

OBJECTIVES: The study aims to determine the degree of perineal trauma, postpartum perineal pain and fetal outcome in both groups using different maneuvers: "hands on" and "hands off" during the late second stage of labor among nulliparous women without episiotomy.DESIGN: Prospective Randomized Research StudySETTING: This study was conducted at the Labor / Delivery room complex from June 2012 to February 2013.METHODS: In the second stage of labor, nulliparous women (120) giving birth were randomly allocated to "hands on"(the fetal head delivery was performed by using a towel-draped, gloved hand exerting forward pressure on the chin of the fetus through the perineum just in front of the coccyx) and "hands off" (the OB resident observed the parturient woman and did not touch perineum during the second stage of labor and the other hand exerts pressure superiorly against the occiput while the fetus was delivering) group. The two groups were compared as to their demographic characteristics, perineal trauma, postpartum pain and neonatal outcomes.RESULTS: All women were nulliparous, term, without episiotomy and had similar demographic characteristics. Pain scores were collected in both groups after delivery. No significant difference in the postpartum pain scale values at 24 hours (p=0.134), 7 days (p=0.866), to 10 days (p=0.77) in both groups. Perineal trauma showed no significant association between laceration (p=0.212). Differences in APGAR Score as a measure of neonatal outcome was similar in both groups.CONCLUSIONS: This study showed that perineal trauma, postpartum perineal pain and neonatal outcome between the "hands on" versus "hands off" have no significant difference. Therefore, it is not necessary to use "hands on" technique on all women in labor during the second stage of labor.