Journal of Arak University of Medical Sciences

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Comparison of the Efficacy and Safety of Insulin with Oral Hypoglycemic Agents in Management of Gestational Diabetes – an Evidence Based Medicine Approach

Babak Eshrati, Maryam Shakiba, Ali Khorshidi, Ali Akbar Mabodi, Habibollah Rahimi,
Volume 17, Issue 6 (9-2014)

Abstract

Background: This study aimed to compare the efficacy and safety of insulin versus oral hypoglycemic drugs for gestational diabetes treatment, using evidence based medicine approach.

Materials and Methods: This secondary study was conducted by selecting a comprehensive systematic review through searching the Cochrane library. To calculate the number needed to treat (NNT), outcomes such as cesarean section, macrosomia, birth weight more than 90th percentile, operative vaginal delivery, labor induction, post partum hemorrhage, and shoulder dystocia has been considered while neonatal hypoglycemia, NICU hospitalization and fetal distress were considered for calculating number needed to harm (NNH). To calculate the likelihood of helped versus harmed (LHH), macrosomia and hypoglysmia were selected. Data were analyzed with Wilson score test.

Results: The NNT for above outcomes were 3, -14, -5, 16, -3, 31, and 32, respectively. Among them cesarean section was significance. Calculated NNH for side effects were 6, 15, and -17 which only was significance for neonatal hypoglycemia (p<0.05). The LHH was estimated -0.43.

Conclusion: Considering LHH, it seems that the benefit of insulin in management of gestational diabetes is more than metformin. But with respect to issues such as low sample size of trials, lack of assessment the maternal hypoglysemia as complication of insulin therapy, the findings should be considered cautiously.

Frequency and causes of caesarean section in primiparous women referred to Taleghani Hospital in Ilam in 2016

Dr Tayebeh Rashidian, Mr , Akbar Mohammadi, Dr Nasibeh Sharifi, Dr Anahita Jalilian, Dr Ali Khorshidi,
Volume 26, Issue 4 (October & November 2023)

Abstract

Introduction: Despite the adverse consequences of cesarean delivery, its incidence rate is increasing in many provinces of the country, especially Ilam city. For this reason, it is important to identify the causes of the increase in cesarean delivery in order to reduce it. Therefore, the present study was conducted with the aim of determining the frequency of cesarean section and its causes in primiparous women in Ilam city in 2016.
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Methodology: The present study was conducted cross-sectionally in the second half of 2016 in Ilam city, and the study population was all primiparous women referred to a single specialty maternity hospital (Ayatollah Taleghani Hospital). The sampling method was census and all cesarean deliveries were recorded in Ayatollah Taleghani Hospital. The inclusion criteria included all primiparous women. The data of the study was collected using a researcher-made questionnaire that included demographic and midwifery information. After collecting the data, the data was entered into the SPSS version 16 software Central indices were used to describe data in quantitative variables, and absolute and cumulative frequency and percentage of dispersion frequency were used for qualitative variables.
Findings: According to the findings of this study, out of 1738 births, 867 (49.88%) were natural births and 871 (50.12%) were cesarean. Among the natural births, 427 (49.25%) and among the cesarean births, 296 (33.98%) were primiparous. Among the maternal factors, lack of progress and among the fetal factors, fetal distress and among the maternal-fetal factors, head-to-pelvis disproportion was one of the most important causes of cesarean delivery in primiparous women. In general, fetal factors with more than 67% were the most important causes of caesarean section in primiparous women.

Conclusion: According to the findings of the study, 33.98% of cesarean births were primiparous. Considering the high statistics of caesarean section, especially cesarean section for first births , It is necessary to reduce the number of elective cesarean sections by increasing the number of physiological births and painless births, as well as increasing the awareness of families about birthing methods and the advantages and disadvantages of each of them.

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