Apr 02, 2010 07:23 PM
Any feedback would be greatly appreciated.
Apr 04, 2010 07:28 PM
Between what is on the thread itself and links out within the posts, I think this thread on gestational diabetes will cover most of what I have to say on GD and induction .
Having a prior c/sec intensifies the reasons not to have an elective delivery at 39 wks, or, frankly, at any time. Inducing labor with a uterine scar is a "batting 0 for 2" proposition. It poses both increased risk of scar rupture and reduced probability of vaginal birth, especially with an unripe cervix and regardless of use of agents or procedures to ready an unripe cervix for labor. Scheduling elective cesarean surgery is an even worse idea. Every subsequent surgery exposes you and your baby not only to the risks of the current surgery but increases the risk of life-threatening complications of placental attachment in any future pregnancies. Even if you do not plan any more children, that is something to consider because many a woman has changed her mind or decided to carry through with an unplanned pregnancy.
I do not know whether requiring insulin changes the equation, although it seems logical, as I wrote in the other GD thread, that if your blood sugars are normal, then you would be at no greater risk. If there is increased risk--and I would want my care provider to give me solid evidence that there was--you will have to weigh it against the risks of planned delivery. If you decide on induction, you can minimize your risk of undesirable outcome by not inducing until the cervix is ripe.
I hope this helps.
All Times America/New_York
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