The outcome of macrosomic fetuses in a low risk primigravid population

Mulik, V.; Kiran, Tanvi; Bethal, J.; Bhal, P. S.

doi:10.1016/s0020-7292(02)00332-6

Cited by 39 publications

(35 citation statements)

References 12 publications

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“…Macrosomia (birthweight >4000 g or >90th centile) is associated with higher rates of a prolonged first and second stage of labour and an increased risk of instrumental vag- inal delivery, shoulder dystocia, Caesarean birth, third-and fourth-degree perineal lacerations, postpartum haemorrhage, prolonged hospital stay, Apgar score <4 and admission to the special care baby unit [8,31,32]. Prevention of macrosomia is therefore mandatory.…”

Section: Discussionmentioning

confidence: 99%

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

2005

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Aims/hypothesis: The aim of this study was to establish the value of maternal HbA 1 c levels and older sibling birthweight as predictors of birthweight and macrosomia in the offspring of women with type 1 diabetes. Subjects and methods: A total of 214 pregnancies of 107 women with type 1 diabetes were studied. Regression analysis was performed to test the predictive value of the birthweight of the first-born infant, HbA 1 c levels, maternal BMI, maternal age and time between subsequent births on the birthweight of the second-born infant. Birthweights were corrected for sex and gestational age. The percentages of first-and second-born infants with macrosomia (weight >90th centile) were calculated and compared. Results: Only the birthweight of earlier born infants was significantly related to that of second-born infants (p<0.001) and 40-50% of the variation in the birthweight of second-born infants could be explained by the birthweight of the firstborn infants. About 85% of the mothers who gave birth to a macrosomic infant had a macrosomic infant in a subsequent pregnancy. Conclusions/interpretation: Although it is clear that glycaemic control contributes to birthweight in women with type 1 diabetes, the birthweight of an earlier born infant appears to be a much better predictor of the birthweight of a subsequent infant than HbA 1 c levels during pregnancy. It may, therefore, be used to identify patients at risk of giving birth to a macrosomic infant. Daily home monitoring of glucose levels, rather than HbA 1 c levels, should be used for assessment of maternal glycaemia during pregnancy.

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Section: Discussionmentioning

confidence: 99%

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

2005

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“…The rate of caesarean section significantly increased among the patients who delivered after labour induction as compared to those whom labour was not induced Shoulder dystocia 3 10 sarean section offer the promise of avoiding trauma to the fetus but can result in increased morbidity in the mother 6 . The safest mode of delivery is controversial with some evidence pointing to elective caesarean section 7 . A fetus was found to be at significantly increased risk for birth weight greater than 4000 gms, when the estimated fetal weight based on abdominal circumference rather than based on head circumference or femur length 8,9 .…”

Section: Resultsmentioning

confidence: 99%

Intrapartum Complications Of Macrosomic Fetus

2007

J Liaquat Uni Med Health Sci

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“…Em Cuba é mencionada taxa de 4,7% 21 . É referido percentual de 9% em estudo que considerou primípa-ras de baixo risco 22 . Merece citação a pesquisa de Sá et al 23 , no Brasil, que menciona taxa de 5,6%.…”

Section: Discussionunclassified

“…As taxas de natimortos nos grupos de macrossômicos e normossômicos foram de 0,5% (n=2) vs 0,3% (n=20), respectivamente. Assim como na literatura, a incidência de neomortos precoces está substancialmente aumentada, contrariamente à de natimortos 20,22 . A macrossomia associada a aumento do risco de tocotraumatismo fetal ocasiona estadia hospitalar prolongada, necessidade de transfusão sangüínea, distocia de ombro, asfixia fetal, tocotraumatismo e fraturas da clavícula e úmero fetal 5,7 .…”

Section: Idade Paridadeunclassified

Fatores maternos e perinatais relacionados à macrossomia fetal

Madi¹,

Rombaldi²,

Filho³

et al. 2006

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivo: identificar fatores maternos e perinatais relacionados a fetos com peso igual ou maior do que 4.000 g no nascimento. Métodos: estudo de corte transversal, de 411 casos consecutivos de macrossomia fetal, ocorridos no período de março de 1998 a março de 2005. Compararam-se os dados obtidos aos de 7.349 casos de fetos com peso entre 2.500 e 3.999 g ao nascimento, ocorridos no mesmo período. Foram analisadas variáveis maternas (idade, paridade, diabete melito, ocorrência de parto cesáreo, mecônio, desproporção feto-pélvica, principais indicações das cesáreas) e perinatais (ocorrência de tocotraumatismo, índice de Apgar inferior a sete no 1º e 5º minuto, natimortalidade, neomortalidade precoce, necessidade de internação na Unidade de Tratamento Intensivo Neonatal). As avaliações estatísticas foram realizadas com o teste não paramétrico do χ 2 com a correção de Yates e com o teste t de Student. Adotou-se o nível de significância de p<0,05. Resultados: as diferenças entre os grupos foram consideradas estatisticamente significantes ao se analisarem a idade materna (p<0,05), paridade (p<0,05) e índice de Apgar menor que 7 no 1º minuto (p<0,05; OR=1,8; IC 95%: 1,4-2,5) e 5º minuto (p<0,05; OR=2,3; IC 95%: 1,3-4,1), diabete melito materno (p<0,05; OR=4,2; IC 95%: 2,7-6,4), ocorrência de mecônio (p<0,05; OR=1,3; IC 95%: 1,0-1,7), necessidade de cuidados intensivos neonatais (p<0,05; OR=2,0; IC 95%: 1,5-2,7), neomortalidade precoce (p<0,05; OR=2,7; IC 95%: 1,0-6,7), parto cesáreo (p<0,05; OR=2,03; IC 95%: 1,6-2,5) e desproporção fetopélvica (p<0,05; OR=2,8; IC 95%: 1,6-4,8), mas não quanto ao tocotraumatismo e à natimortalidade. No grupo de fetos macrossômicos, as principais indicações de operação cesariana foram a iteratividade (11,9%) e a desproporção fetopélvica (8,6%). No grupo controle as principais indicações foram a iteratividade (8,3%) e o sofrimento fetal agudo (3,9%). Conclusão: a despeito das limitações características de uma avaliação retrospectiva, o estudo demonstra quais complicações tendem a se associar ao excessivo tamanho fetal, podendo ser de utilidade no manejo obstétrico de pacientes com suspeita de crescimento fetal excessivo. A macrossomia fetal permanece sendo problema obstétrico de difícil solução, associado a importantes conseqüências maternas e perinatais, haja vista as significantes taxas de morbiletalidade observadas em países desenvolvidos e em desenvolvimento. PALAVRAS-CHAVE: Macrossomia fetal; Morbidade materna; Morbidade fetal; Peso fetalABSTRACT Purpose: to identify maternal and perinatal factors related to neonates with birthweight ≥4,000 g. Methods: cross-section cohort study with 411 consecutive cases of fetal macrosomia (FM) which occurred from March 1998 to March 2005. Data were compared to 7,349 cases of fetal birthweight ≥2,500 and <3,999 g which occurred in the same period. Maternal variables (maternal age, parity, diabetes, previous cesarean section, meconium-stained amniotic fluid, cephalopelvic disproportion, main cesarean section indications) and perinatal variabl...

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The outcome of macrosomic fetuses in a low risk primigravid population

Cited by 39 publications

References 12 publications

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

Sibling birthweight as a predictor of macrosomia in women with type 1 diabetes

Intrapartum Complications Of Macrosomic Fetus

Fatores maternos e perinatais relacionados à macrossomia fetal

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