DDC-crashing from the March thread.
I'm scheduled to take my glucose test next week. I've refused it the last 2 pregnancies (failed the screen my first pregnancy, and then did fine on the 3 hr. fasting one afterwards), and was ready to refuse it again, mostly because I wasn't about to be convinced of an early delivery for macrosomia, no matter what dx they give me. Also because I'm fairly low risk. But, my OB nurse (who's a Doctor of nursing & is really great) talked me into it this time by talking about the reasons it will change the care the baby receives after
the birth, if there is a diabetes dx.
As for macrosomia & "automatic" c-sections, there has been recent evidence that that link is much weaker than previously thought. Plus, they can't force
you to have a c-section. Coerce, yes, but force, no. I copied a couple of pubmed-linked articles (just the conclusions for brevity, but you can look them up) about glucose/insulin and birthweight below. Hope that helps.
J Reprod Med.
Third trimester insulin levels are not correlated with fetal macrosomia or delivery complications.
, Brown M
, Karnitis VJ
Our data indicates that neither insulin nor glucose levels are predictive of fetal macrosomia, low Apgar scores, or birth injuries.
BMC Pregnancy Childbirth.
2014 May 1;14:156. doi: 10.1186/1471-2393-14-156.
Does induction of labor for constitutionally large-for-gestational-age fetuses identified in utero reduce maternal morbidity?
, Rivière O
, Neveu B
, Lémery D
; Audipog Sentinel Network
A policy of induction of labor for women with a constitutionally large-for-gestational-age fetus among women without diabetes does not reduce maternal morbidity.
Am J Obstet Gynecol.
Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery.
, Bader D
, Ajami M
During the 4 years of the study 16,416 deliveries resulted in 133 infants with macrosomia (0.8%). Macrosomia was suspected in 47 cases and confirmed by birth weight in 21 (45%). Antenatal estimation of fetal weight was carried out for 115 of the fetuses with macrosomia (86%). Macrosomia was correctly predicted in 21 of 115 cases (18.3%). Thirteen infants with undiagnosed macrosomia were delivered by emergency cesarean procedures, and 99 were delivered vaginally. Three infants with macrosomia (3%) and 14 infants without macrosomia (0.1%) sustained brachial plexus injury. Our policy prevented at most a single case of brachial palsy, and it contributed 0.16% to our cesarean delivery rate.
A policy of elective cesarean delivery in cases of suspected fetal macrosomia had an insignificant effect on the incidence of brachial plexus injury. Its contribution to the rate of cesarean delivery was also small.