The new ACOG Practice Bulletin for Gestational Diabetes is very interesting and informative.ACOG now accepts that monitoring for gestational diabetes should be performed after a meal.ACOG states that " macrosomia, neonatal hypogkycemia and cesearian sections for shoulder dystocia were lower among women with post prandial monitoring" Post prandial means following a meal.
Also, "macrosomia is distinctly more common in women with GDM. Shoulder dystocia is more likely at a given birth weight in pregnancies complicated by diabetes. Of more importance if the language ACOG uses in the practice bulletin concerning cesearian section. ACOG itself now states that is may be reasonable to recommend cesearian section delivery WITHOUT A TRIAL OF LABOR at some threshold of fetal weight. The question is what weight. While it has been generally accepted that that number was 4500 grams., ACOG now accepts the number may be lower to 4000 grams. At 4000-4500 grams ACOG states that additional factors such as the patients past history, clinical pelvimetry anf the progree of labor may be important to consider.
These are important changes by ACOG. Slowly they are coming around to the view that women should be offered the option of cesearian delivery more often, Had the suggestions in the new technical bulletin been followed for the past several years, many of the brachial plexus injuries suffered by your chilren could have been avoided.
If anyone would like a copy of the bulletin, please write or email and I will send it to you free of charge. If anyone has a questions about the bulletin, please do not hesitate to contact me.
Ken Levine
BRL77@world.std.com
617-566-2700