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Lau SL, Sin WTA, Wong L, Lee NMW, Hui SYA, Leung TY. A critical evaluation of the external and internal maneuvers for resolution of shoulder dystocia. Am J Obstet Gynecol 2024; 230:S1027-S1043. [PMID: 37652778 DOI: 10.1016/j.ajog.2023.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 09/02/2023]
Abstract
In the management of shoulder dystocia, it is often recommended to start with external maneuvers, such as the McRoberts maneuver and suprapubic pressure, followed by internal maneuvers including rotation and posterior arm delivery. However, this sequence is not based on scientific evidence of its success rates, the technical simplicity, or the related complication rates. Hence, this review critically evaluates the success rate, technique, and safety of different maneuvers. Retrospective reviews showed that posterior arm delivery has consistently higher success rates (86.1%) than rotational methods (62.4%) and external maneuvers (56.0%). McRoberts maneuver was thought to be a simple method, however, its mechanism is not clear. Furthermore, McRoberts position still requires subsequent traction on the fetal neck, which presents a risk for brachial plexus injury. The 2 internal maneuvers have anatomic rationales with the aim of rotating the shoulders to the wider oblique pelvic dimension or reducing the shoulder width. The techniques are not more sophisticated and requires the accoucher to insert the correct hand (according to fetal face direction) through the more spacious sacro-posterior region and deep enough to reach the fetal chest or posterior forearm. The performance of rotation and posterior arm delivery can also be integrated and performed using the same hand. Retrospective studies may give a biased view that the internal maneuvers are riskier. First, a less severely impacted shoulder dystocia is more likely to have been managed by external maneuvers, subjecting more difficult cases to internal maneuvers. Second, neonatal injuries were not necessarily caused by the internal maneuvers that led to delivery but could have been caused by the preceding unsuccessful external maneuvers. The procedural safety is not primarily related to the nature of the maneuvers, but to how properly these maneuvers are performed. When all these maneuvers have failed, it is important to consider the reasons for failure otherwise repetition of the maneuver cycle is just a random trial and error. If the posterior axilla is just above the pelvic outlet and reachable, posterior axilla traction using either the accoucher fingers or a sling is a feasible alternative. Its mechanism is not just outward traction but also rotation of the shoulders to the wider oblique pelvic dimension. If the posterior axilla is at a higher sacral level, a sling may be formed with the assistance of a long right-angle forceps, otherwise, more invasive methods such as Zavanelli maneuver, abdominal rescue, or symphysiotomy are the last resorts.
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Affiliation(s)
- So Ling Lau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wing To Angela Sin
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lo Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Nikki May Wing Lee
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shuk Yi Annie Hui
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Ding W, Lau SL, Wang CC, Zhang T, Getsko O, Lee NMW, Chim SSC, Wong CK, Leung TY. Dynamic changes in maternal immune biomarkers during labor in nulliparous vs multiparous women. Am J Obstet Gynecol 2022; 227:627.e1-627.e23. [PMID: 35609644 DOI: 10.1016/j.ajog.2022.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/24/2022] [Accepted: 05/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Immunomodulation is observed in human parturition. However, data from longitudinal studies for the prelabor phase and the active phase of labor are lacking, and no study had compared the immune responses during labor between nulliparous and multiparous women. OBJECTIVE This study aimed to investigate the temporal changes of immune biomarkers in maternal blood from the prelabor phase to the latent and active phases of labor and to compare the dynamic changes between nulliparous and multiparous women. STUDY DESIGN A prospective case-control study was conducted on women who had induction of labor at term followed by vaginal delivery. Maternal blood was serially collected at 3 consecutive time points: (1) before the onset of labor, (2) during the latent phase of labor, and (3) during the active phase of labor. Peripheral immune cells were measured by 4-color flow cytometry, and the plasma concentrations of cytokines and chemokines were measured by cytometric bead arrays. A longitudinal comparison was made to assess the dynamic changes in inflammatory parameters over 3 time points in nulliparous and multiparous women, respectively, and a cross-sectional comparison was made between nulliparous and multiparous women. RESULTS A total of 40 women, including 20 nulliparous and 20 multiparous, were included in the study. Prelabor circulating levels of macrophage inflammatory protein-1β, monokine induced by gamma interferon, and interferon gamma-induced protein-10 were higher in multiparous women than in nulliparous women. In the latent phase of labor, the innate immune system in both groups responded with increases in neutrophils and interleukin 6, and the nulliparous women showed a more pronounced response. During the active phase of labor, such innate immune response continued with both groups, with additional increases in natural killer cells, monocyte chemoattractant protein-1, interleukin 8, and interleukin 10. Conversely, the adaptive immune system in nulliparous women showed a reduction in both cytotoxic and helper T cells, whereas the adaptive immune system in multiparous women only had a reduction in helper T cells, showing a smaller reduction. CONCLUSION Innate and adaptive immune responses partake in immunomodulation during human parturition. Nulliparous and multiparous women showed different responses in their blood levels of immune cells and biomarkers during the different phases of labor.
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Kwan AHW, Hui ASY, Lee JHS, Leung TY. Intrauterine fetal death followed by shoulder dystocia and birth by modified posterior axillary sling method: a case report. BMC Pregnancy Childbirth 2021; 21:672. [PMID: 34602052 PMCID: PMC8489078 DOI: 10.1186/s12884-021-04126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022] Open
Abstract
Background Various manoeuvres such as McRoberts position, suprapubic pressure, rotational methods, posterior arm extraction and all-four position (HELPERR) have been proposed for relieving shoulder dystocia with variable success. Posterior axillary sling method using a rubber catheter was proposed in 2009 but has not been widely used. We modified this method using ribbon gauzes and a long right-angle forceps and report a successful case. Case presentation A 44 years old parity one Chinese woman with a history of a caesarean delivery and poorly controlled type 2 diabetes mellitus was admitted to the Accident and Emergency Department for advanced stage of labour at term. Upon arrival, intrauterine fetal demise was diagnosed with severe asynclitism causing obstruction at the perineum. Episiotomy resulted in birth of the fetal head. The fetal posterior right shoulder, however, remained very high up in the pelvis and HELPERR methods failed to extract the shoulders. We then tied two long ribbon gauzes together, and guided its knot to the anterior aspect of the posterior axilla. By using a long right-angle forceps (24 cm long) to grasp the knot on the posterior side of the axilla and pulling it through, a sling was formed. Traction was then applied through the sling to simultaneously pull and rotate the posterior shoulder. A stillbirth of 3488 g was finally extracted. Conclusions We modified the sling method by using two ribbon gauzes, tied together and a right-angle forceps with several advantages. Compared to a rubber catheter, ribbon gauze with a knot can be easily held between the fingers for easy guidance past the fetal axilla. It is also thin, non-elastic and stiff enough to ensure a good grip for traction. The long and slim design of the right-angle forceps makes it easy to pass through a narrow space and reach the axilla high up in the pelvis. We emphasize simultaneous traction and rotation, so that the shoulders are delivered through the wider oblique pelvic outlet dimension. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04126-4.
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Affiliation(s)
- Angel Hoi Wan Kwan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Annie Shuk Yi Hui
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Jacqueline Ho Sze Lee
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
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Harvey L, van Elburg R, van der Beek EM. Macrosomia and large for gestational age in Asia: One size does not fit all. J Obstet Gynaecol Res 2021; 47:1929-1945. [PMID: 34111907 DOI: 10.1111/jog.14787] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 12/17/2022]
Abstract
Macrosomia, usually defined as infant birth weight of ≥4000 g, does not consider gestational age, sex, or country/region-specific differences in mean birth weight and maternal body weight. This issue is particularly relevant for Asia, where 60% of the world's population lives, due to variations in maternal size and birth weights across populations. Large for gestational age (LGA), defined as birth weight > 90th centile, is a more sensitive measure as it considers gestational age and sex, though it is dependent on the choice of growth charts. We aimed to review reporting of macrosomia and LGA in Asia. We reviewed the literature on prevalence and risk of macrosomia and LGA in Asia over the last 29 years. Prevalence of macrosomia ranged from 0.5% (India) to 13.9% (China) while prevalence of LGA ranged from 4.3% (Korea) to 22.1% (China), indicating substantial variation in prevalence within and between Asian countries. High pre-pregnancy body mass index, excessive gestational weight gain, and impaired glucose tolerance conferred risk of macrosomia/LGA. Incidence of macrosomia and LGA varies substantially within and between Asian countries, as do the growth charts and definitions. The latter makes it impossible to make comparisons but suggests differences in intrauterine growth between populations. Reporting LGA, using standardized country/regional growth charts, would better capture the incidence of high birth weight and allow for comparison and identification of contributing factors. Better understanding of local drivers of excessive intrauterine growth could enable development of improved strategies for prevention and management of LGA.
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Affiliation(s)
- Louise Harvey
- Nutricia Research, Danone Nutricia Research, Utrecht, The Netherlands
| | - Ruurd van Elburg
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Eline M van der Beek
- Department of Pediatrics, University Medical Centre Groningen, Groningen, The Netherlands
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Wong L, Tse WT, Lai CY, Hui ASY, Chaemsaithong P, Sahota DS, Poon LC, Leung TY. Bradycardia‐to‐delivery interval and fetal outcomes in umbilical cord prolapse. Acta Obstet Gynecol Scand 2020; 100:170-177. [DOI: 10.1111/aogs.13985] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Lo Wong
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Wing T. Tse
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Chit Y. Lai
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Annie S. Y. Hui
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Daljit S. Sahota
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Liona C. Poon
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
| | - Tak Y. Leung
- Department of Obstetrics and Gynecology The Chinese University of Hong Kong Hong Kong Hong Kong
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Kang X, Liang Y, Wang S, Hua T, Cui J, Zhang M, Ding Y, Chen L, Xiao J. Prediction model comparison for gestational diabetes mellitus with macrosomia based on risk factor investigation. J Matern Fetal Neonatal Med 2019; 34:2481-2490. [PMID: 31575301 DOI: 10.1080/14767058.2019.1668922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To establish a feasible prediction model for gestational diabetes mellitus (GDM) with macrosomia based on risk factors analysis. METHODS A total of 1981 GDM pregnant women with macrosomia were enrolled in this retrospective study. The potential risk factors were revealed between the GDM women with and without macrosomia based on questionnaire and clinical data analysis. Then, prediction models including logistic regression (LR), decision tree (DT), support vector machine (SVM) and artificial neural networks (ANN) were constructed using these risk factors. Effect evaluation was performed based on model forecasting ability and model practicability such as accuracy, true positive (TP) rate, false positive (FP) rate, recall, F-measure, and receiver operating characteristic curve (ROC). RESULTS The risk factors analysis showed that factors such as triglyceride (TG), high-density lipoprotein-cholesterol (HDL-c) and ketone body were risk factors for GDM with macrosomia. Then, the forecasting model was constructed, respectively. Based on these risk factors as variables, the overall classification accuracy of the four forecasting models was 86%. DT model had the highest overall classification accuracy. SVM model had advantages over the other three models in terms of TP rate. Among the comparison parameters including overall ROC curve, ANN model was the highest, followed by LR model. CONCLUSION Among four forecasting models, ANN might be the optimal predication model, which had a certain practical value for the clinical screening of GDM women combined with macrosomia. Furthermore, HDL-c, TG, and ketone body might be potential risk factors for GDM with macrosomia.
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Affiliation(s)
- Xinyi Kang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Yuanyuan Liang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Shiyu Wang
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Tianqi Hua
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China
| | - Jiawen Cui
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Mingjin Zhang
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Yunjunyu Ding
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Liping Chen
- Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Nantong University/The First People's Hospital of Nantong, Nantong, China
| | - Jing Xiao
- Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China.,Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Hou Q, Huang L, Ge X, Yang A, Luo X, Huang S, Xiao Y, Jiang C, Li L, Pan Z, Teng T, Zhang H, Li M, Mo Z, Yang X. Associations between multiple serum metal exposures and low birth weight infants in Chinese pregnant women: A nested case-control study. CHEMOSPHERE 2019; 231:225-232. [PMID: 31129403 DOI: 10.1016/j.chemosphere.2019.05.103] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/28/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
To investigate the associations between prenatal exposure to single metal and multiple metals and the risk of low birth weight (LBW), we conducted a nested case-control study of 246 LBW and 406 NBW mother-infant pairs based on a prospective birth cohort study. 22 serum metals were detected by inductively coupled plasma quadruple mass spectrometry (ICP-MS). Categorical analyses showed serum Co and Ti were associated with LBW (Co: 3rd vs 4th. quartile: OR = 1.83, 95%CI: 1.14-2.92, Ptrend = 0.043; Ti: 2nd vs. 4th quartile: OR = 0.51, 95% CI: 0.32-0.81, P trend = 0.051), especially gestational age >13 weeks (Co: 3rd vs. 4th quartile: OR = 1.94, 95% CI: 1.13 - 3.32, Ptrend = 0.043; Ti: 2nd vs. 4th quartile: OR = 0.50, 95% CI: 0.30 - 0.84, P trend= 0.073). Cubic spline analyses showed serum Co and serum Ti had non-linearity associations with LBW (Co: P for overall = 0.048, P-nonlinearity = 0.014; Ti: P for overall = 0.015, P- nonlinearity = 0.008). In multi-metal compound exposure model, 15 metals selected by elastic net model were significantly associated with the increased risk of LBW and OR (95%CI) was 5.14 (2.81-9.40). Our study suggested that lower level serum Co was positively associated with LBW and lower level serum Ti was negatively associated with LBW, especially gestational age >13 weeks, and both of them had non-linearity dose-relationships with LBW. And multi-metal compound model was significantly associated with LBW compared with single metal model.
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Affiliation(s)
- Qingzhi Hou
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Lulu Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiaoting Ge
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Aimin Yang
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong SAR
| | - Xiaoyu Luo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Sifang Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Yang Xiao
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chao Jiang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Longman Li
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Zhijian Pan
- Department of Gynecology and Obstetrics, the Maternal & Child Health Hospital of Qinzhou, Qinzhou, Guangxi, China
| | - Tao Teng
- Department of Antenatal Care, the Maternal & Child Health Hospital of Nanning, Nanning, Guangxi, China
| | - Haiying Zhang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China
| | - Mujun Li
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China
| | - Xiaobo Yang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi, China; Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi, China; Department of Occupational Health and Environmental Health, School of Public Health of Guangxi Medical University, Nanning, Guangxi, China.
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Cheng Y, Leung TY, Lao T, Chan YM, Sahota DS. Impact of replacing Chinese ethnicity-specific fetal biometry charts with the INTERGROWTH-21(st) standard. BJOG 2018; 123 Suppl 3:48-55. [PMID: 27627597 DOI: 10.1111/1471-0528.14008] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the impact of adopting the INTERGROWTH-21(st) biometry standards in a Chinese population. DESIGN Retrospective cohort study. SETTING A teaching hospital in Hong Kong. POPULATION A total of 10 527 Chinese women with a singleton pregnancy having a second- or third-trimester fetal anomaly or growth scan between January 2009 and June 2014. METHODS Z-scores were derived for fetal abdominal circumference (AC), head circumference (HC), and femur length (FL) using the INTERGROWTH-21(st) and Chinese biometry standards. Pregnancies with aneuploidy, structural or skeletal abnormalities, or that developed pre-eclampsia were excluded. Z-scores were stratified as <2.5th, <5th, <10th, >90th, >95th, or >97.5th percentile. Birthweight centile, adjusted for gestation and gender, was categorised as ≤3rd, 3rd to ≤5th, 5th to ≤10th, and >10th. Pairwise comparison and the McNemar test were performed to assess biometry Z-score differences and concordance between the INTERGROWTH-21(st) and Chinese standards. MAIN OUTCOME MEASURES The sensitivity of both the local and INTERGROWTH-21(st) AC standards to identify pregnancies that were small-for-gestational-age (SGA) was assessed. RESULTS INTERGROWTH-21(st) AC, HC, and FL Z-scores were significantly lower than those obtained using our local reference for AC, HC, and FL (P < 0.0001 for all). The proportion of fetuses with biometry in the <2.5th, <5th, <10th, >90th, >95th, or >97.5th percentiles was statistically significant (P < 0.01 for all). A total of 1224 (15.5%) of the scans at 18-22 weeks of gestation had AC, HC, or FL below the 3rd percentile of the INTERGROWTH-21(st) standard. CONCLUSIONS Adopting the INTERGROWTH-21(st) standard would lead to a significant number of fetuses being at risk of misdiagnosis for small fetal size, particularly when using HC and FL measures. TWEETABLE ABSTRACT INTERGROWTH-21(st) biometry assessment in Chinese leads to fetuses being at risk of misdiagnosis of small fetal size.
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Affiliation(s)
- Yky Cheng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - T Y Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Tth Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - Y M Chan
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| | - D S Sahota
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Jiang C, Hou Q, Huang Y, Ye J, Qin X, Zhang Y, Meng W, Wang Q, Jiang Y, Zhang H, Li M, Mo Z, Yang X. The effect of pre-pregnancy hair dye exposure on infant birth weight: a nested case-control study. BMC Pregnancy Childbirth 2018; 18:144. [PMID: 29743046 PMCID: PMC5944114 DOI: 10.1186/s12884-018-1782-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Abstract
Background Limited evidences were reported about the risk of pre-pregnancy hair dye use or irregular menstruation with abnormal birth weight during pregnancy, and their joint effects were also unknown. The aim of our study was to explore whether the pre-pregnancy exposure of hair dye and irregular menstruation were associated with the risk of abnormal birth weight. Methods We conducted a nested case-control study from a prospective cohort of 6203 pregnant women. Low birth weight study included 315 mother-infant pairs (105 LBW cases and 210 matched controls), and macrosomia study included 381 mother-infant pairs (127 macrosomia cases and 254 matched controls). Meanwhile, lifestyle information including hair dying custom and menstrual history were collected by face-to-face questionnaires and birth outcomes were extracted from the medical records. The logistic regressions models were used to analyze the join effect of irregular menstruation and hair dye use. Results Pre-pregnancy hair dye use was associated with increased risk of LBW (adjusted OR = 1.71, 95% CI: 1.01–2.92, P = 0.048). Irregular menstruation had high risk of LBW (adjusted OR = 2.79, 95% CI: 1.53–5.09, P = 0.001) and macrosomia (adjusted OR = 1.93, 95% CI: 1.09–3.44, P = 0.023). Additionally, in the LBW study, women who used hair dye with pre-pregnancy BMI < 18.5 kg/m2 had higher OR than those with only one risk factor (3.07 vs 2.53, Ptrend = 0.015), and women with both hair dye use and irregular menstruation also had higher risk than those with only one factor (4.53 vs 2.07, Ptrend = 0.05). Moreover, in macrosomia study, women with irregular menstruation and pre-pregnancy BMI ≥ 24 kg/m2 had higher risk than those with one factor (13.31 vs 2.09, Ptrend = 0.001). Conclusion Our study showed that either pre-pregnancy hair dye use or irregular menstruation was associated with abnormal birth weight, especially, their joint effects could furthermore increase the risk of low birth weight infants when these two factors existed simultaneously.
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Affiliation(s)
- Chao Jiang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China.,Department of Occupational and Environmental Medicine School of Public Health, Guangxi Medical University, 22 Shuangyong Rd, Nanning, 530021, Guangxi, China
| | - Qingzhi Hou
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China.,Department of Occupational and Environmental Medicine School of Public Health, Guangxi Medical University, 22 Shuangyong Rd, Nanning, 530021, Guangxi, China
| | - Yaling Huang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Juan Ye
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xiaolian Qin
- Department of Antenatal care, the Maternal & Child Health Hospital of Yulin, Yulin, Guangxi, China
| | - Yu Zhang
- Department of Gynecology and Obstetrics, the Maternal & Child Health Hospital of Liuzhou, Liuzhou, Guangxi, China
| | - Wen Meng
- Department of Medical Services Section, the Maternal & Child Health Hospital of Guigang, Guigang, Guangxi, China
| | - Qiuyan Wang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yonghua Jiang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Haiying Zhang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China.,Department of Occupational and Environmental Medicine School of Public Health, Guangxi Medical University, 22 Shuangyong Rd, Nanning, 530021, Guangxi, China
| | - Mujun Li
- Department of Reproductive Center, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Zengnan Mo
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China.,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Xiaobo Yang
- Center for Genomic and Personalized Medicine, Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China. .,Guangxi key Laboratory for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China. .,Guangxi Collaborative Innovation Center for Genomic and Personalized Medicine, Nanning, Guangxi Zhuang Autonomous Region, China. .,Guangxi Key Laboratory of Colleges and Universities, Nanning, Guangxi Zhuang Autonomous Region, China. .,Department of Occupational and Environmental Medicine School of Public Health, Guangxi Medical University, 22 Shuangyong Rd, Nanning, 530021, Guangxi, China.
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10
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Santos P, Hefele JG, Ritter G, Darden J, Firneno C, Hendrich A. Population-Based Risk Factors for Shoulder Dystocia. J Obstet Gynecol Neonatal Nurs 2017; 47:32-42. [PMID: 29221671 DOI: 10.1016/j.jogn.2017.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To re-examine the risk factors for shoulder dystocia given the increasing rates of obesity and diabetes in pregnant women. DESIGN Retrospective observational study. SETTING Five hospitals located in Wisconsin, Florida, Maryland, Michigan, and Alabama. PARTICIPANTS We evaluated 19,236 births that occurred between April 1, 2011, and July 25, 2013. METHODS Data were collected from electronic medical records and used to evaluate the risk of shoulder dystocia. Data were analyzed using a generalized linear mixed model, which controlled for clustering due to site. RESULTS When insulin was prescribed, gestational diabetes was associated with an increased risk of shoulder dystocia (odds ratio = 2.10, 95% confidence interval [1.01, 4.37]); however, no similar association was found with regard to gestational diabetes treated with glycemic agents or through diet. Use of epidural anesthesia was associated with an increased risk for shoulder dystocia (odds ratio = 3.47, 95% confidence interval [2.72, 4.42]). Being Black or Hispanic, being covered by Medicaid or having no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes were other significant risk factors. CONCLUSION With the changing characteristics of pregnant women, labor and birth clinicians care for more pregnant women who have an increased risk for shoulder dystocia. Our findings may help prospectively identify women with the greatest risk.
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11
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Risk Factors for Shoulder Dystocia: the Impact of Mother's Race and Ethnicity. J Racial Ethn Health Disparities 2017; 5:333-341. [PMID: 28447275 DOI: 10.1007/s40615-017-0374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/11/2016] [Accepted: 04/18/2017] [Indexed: 10/19/2022]
Abstract
Shoulder dystocia is a rare but severe birth trauma where the neonate's shoulders fail to deliver after delivery of the head. Failure to deliver the shoulders quickly can lead to severe, long-term injury to the infant, including nerve injury, skeletal fractures, and potentially death. This observational study examined shoulder dystocia risk factors by race and ethnicity using a sample of 19,236 pregnant women who presented for labor and delivery from July 1, 2010 until June 30, 2013 at five locations. Multivariate analyses were used to identify risk factors associated with shoulder dystocia occurrence in racial/ethnic groups with high incidence rates. For White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.5, 3.9; p < .01) and use of epidural anesthesia during delivery (OR = 4.4; 95% CI = 3.0, 6.4; p < .01). Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural (OR = 5.3; 95% CI = 3.2, 8.7; p < .01) and having gestational diabetes and controlling the condition with insulin (OR = 4.6; 95% CI = 1.5, 13.8; p < .01). Additionally, among Hispanic mothers, having Spanish as primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language (OR = 2.3; 95% CI = 1.1, 4.6; p < .05). This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups. These differences emphasize the importance of evaluating risk by population subgroups and might provide a basis for labor and delivery clinicians to enhance personalized medicine to reduce adverse events.
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12
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Wang Y, Mao J, Wang W, Qiou J, Yang L, Chen S. Maternal fat free mass during pregnancy is associated with birth weight. Reprod Health 2017; 14:47. [PMID: 28351407 PMCID: PMC5371275 DOI: 10.1186/s12978-017-0308-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/13/2017] [Indexed: 12/22/2022] Open
Abstract
Background The relationship between maternal body compositions and birth weight was not definite. Fat Mass (FM) and Fat Free Mass (FFM) can accurately reflect the maternal body fat compositions and have been considered as better predictors of birth weight. Despite its potential role, no studies have been described the maternal compositions during pregnancy in East Asian women previously. We investigated the correlation between birth weight and Maternal body composition including fat mass (FM) and fat free mass (FFM). To determine whether birth weight is associated with maternal body fat FM and FFM during pregnancy and, if so, which trimester and parameter is more critical in determining birth weight. Methods A longitudinal prospective observational study performed, 348, 481 and 321 non-diabetics Han Chinese women with a singleton live birth attending a routine visit in their first, second and third trimesters were recruited. Maternal body composition was measured using segmental multi-frequency bioelectrical impedance analysis. Data of the pre-pregnancy body mass index (BMI), maternal BMI, the gestational weight gain (GWG), and placental and birth weight were collected. Results A significant correlation exists between maternal FFM in the process of pregnancy, placental weight, GWG at delivery, and birth weight (P < 0.05). On stepwise multiple linear regression analysis, material’s FFM was the most important factor associated with the birth weight. After adjustment, there was significantly associated with 2.47-fold increase in risk for birth weight more than 4 kg when FFM ≥ 40.76 kg (Upper quartile of participants). The increased maternal age became a protective factor (OR = 0.69) while the increased pre-pregnancy BMI (OR = 1.50) remained predictors to birth weight more than 4 kg. Conclusions The change of maternal FFM during pregnancy is independently affected the birth weight.
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Affiliation(s)
- Yanxia Wang
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China.
| | - Jie Mao
- Department of Nutrition, Lanzhou University the Second hospital, Lanzhou, Gansu, China
| | - Wenling Wang
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China
| | - Jie Qiou
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China
| | - Lan Yang
- Institute of Maternity and Child-Care Research, Gansu Provincial Maternity and Child-care Hospital, No.143.Qilihe north Rd., Lanzhou, Gansu, 730030, People's Republic of China
| | - Simin Chen
- Department of Nutrition, Lanzhou University the Second hospital, Lanzhou, Gansu, China
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13
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Lok ZLZ, Cheng YKY, Leung TY. Predictive factors for the success of McRoberts' manoeuvre and suprapubic pressure in relieving shoulder dystocia: a cross-sectional study. BMC Pregnancy Childbirth 2016; 16:334. [PMID: 27793109 PMCID: PMC5086064 DOI: 10.1186/s12884-016-1125-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 10/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND McRoberts' and suprapubic pressure are often recommended as the initial choices of manoeuvres to manage shoulder dystocia, as they are believed to be less invasive compared to other manoeuvres. However, their success rates range from 23 to 40 %. This study aims to investigate the predictive factors for the success of McRoberts' manoeuvre with or without suprapubic pressure (M+/-S). METHODS All cases of shoulder dystocia in a tertiary hospital in South East Asia were recruited from 1995 to 2009. Subjects were analysed according to either 'success' or 'failure' of M+/-S. Maternal and fetal antenatal and intrapartum factors were compared by univariate and multivariate analysis. RESULTS Among 198 cases of shoulder dystocia, M+/-S as the primary manoeuvre was successful in 25.8 %. The other 74.2 % needed either rotational or posterior arm manoeuvres or combination of manoeuvres. Instrumental delivery was the single most significant factor associated with an increased risk of failed M+/-S on logistic regression (p < 0.001, OR 4.88, 95 % CI 2.05-11.60). The success rate of M+/-S was only 15.0 % if shoulder dystocia occurred after instrumental delivery but was 47.7 % after spontaneous vaginal delivery. CONCLUSIONS When shoulder dystocia occurs after instrumental vaginal delivery, the chance of failure of M+/-S is 85 %, which is 4.7 times higher than that after spontaneous vaginal delivery. Hence all operators performing instrumental delivery should be proficient in performing all manoeuvres to relieve shoulder dystocia when M+/-S cannot do so.
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Affiliation(s)
- Zara Lin Zau Lok
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China
| | - Yvonne Kwun Yue Cheng
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, Hong Kong SAR, China.
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Luhete PK, Mukuku O, Kiopin PM, Tambwe AM, Kayamba PKM. [Fetal macrosomia in Lubumbashi: risk factors and maternal and perinatal prognosis]. Pan Afr Med J 2016; 23:166. [PMID: 27303582 PMCID: PMC4894667 DOI: 10.11604/pamj.2016.23.166.7362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/02/2016] [Indexed: 02/05/2023] Open
Abstract
Introduction La macrosomie fœtale est habituellement définie par un poids de naissance supérieur ou égal à 4000 grammes. L'objectif de cette étude est de déterminer la fréquence de la macrosomie, d'identifier les facteurs étiologiques et d’évaluer le pronostic maternel et périnatal. Méthodes Il s'agit d'une étude cas-témoins menéeau sein des maternités de 10 hôpitaux généraux de référence de la ville de Lubumbashi en République Démocratique du Congoentre le 1er décembre 2013 et le 31 mars 2014. Les accouchées ont été réparties en deux groupes, en fonction du poids de naissance de leurs nouveau-nés: groupe I (≥4000 grammes ou plus) et groupe II (2500 à 3500 grammes). Les caractéristiques maternelles, l'environnement obstétrical ainsi que le pronostic maternel et périnatal ont été étudiés et comparés dans les deux groupes. Les données ont été analysées à l'aide du logiciel Épi info version 7.1. Les différences étaient jugées significatives pour un seuil de p<0,05. Résultats Au total, 668 mères et leurs nouveau-nés ont été inclus dont 167 macrosomes et 501témoins. L'incidence de la macrosomie fœtale était de 5,7%. Comparativement aux mères de témoins, nous avons trouvé que les mères des nouveau-nés macrosomes étaient plus âgées, multipares, multigestes, obèses, diabétiques et avaient antérieurement donné naissance à un macrosome. Les taux de césarienne et de délivrance pathologique étaient significativement élevés chez les mères de macrosomes que chez celles de témoins. Lesexe masculin était significativement plus prédominant chez macrosomes que chez les témoins. La dystocie des épaules étaitenregistrée uniquement dans le groupe des macrosomes. Conclusion La prévalence de l'accouchement d'un macrosome à Lubumbashi est de 5,7%. La macrosomie est souvent à l'origine de complications maternelles et périnatales. La réduction de ces dernières passe par une meilleure connaissance des facteurs de risque et un dépistage précoce.
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Affiliation(s)
- Prosper Kakudji Luhete
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Olivier Mukuku
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Patrick Mubinda Kiopin
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
| | - Albert Mwembo Tambwe
- Département de Gynécologie-Obstétrique, Faculté de Médecine, Université de Lubumbashi, République Démocratique du Congo
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Yang S, Peng A, Wei S, Wu J, Zhao J, Zhang Y, Wang J, Lu Y, Yu Y, Zhang B. Pre-Pregnancy Body Mass Index, Gestational Weight Gain, and Birth Weight: A Cohort Study in China. PLoS One 2015; 10:e0130101. [PMID: 26115015 PMCID: PMC4482572 DOI: 10.1371/journal.pone.0130101] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 05/15/2015] [Indexed: 12/02/2022] Open
Abstract
Objective To assess whether pre-pregnancy body mass index (BMI) modify the relationship between gestational weight gain (GWG) and child birth weight (specifically, presence or absence of low birth weight (LBW) or presence of absence of macrosomia), and estimates of the relative risk of macrosomia and LBW based on pre-pregnancy BMI were controlled in Wuhan, China. Methods From June 30, 2011 to June 30, 2013. All data was collected and available from the perinatal health care system. Logistic regression models were used to estimate the independent association among pregnancy weight gain, LBW, normal birth weight, and macrosomia within different pre-pregnancy BMI groups. We built different logistic models for the 2009 Institute of Medicine (IOM) Guidelines and Chinese-recommended GWG which was made from this sample. The Chinese-recommended GWG was derived from the quartile values (25th-75th percentiles) of weight gain at the time of delivery in the subjects which comprised our sample. Results For LBW children, using the recommended weight gain of the IOM and Chinese women as a reference, the OR for a pregnancy weight gain below recommendations resulted in a positive relationship for lean and normal weight women, but not for overweight and obese women. For macrosomia, considering the IOM’s recommended weight gain as a reference, the OR magnitude for pregnancy weight gain above recommendations resulted in a positive correlation for all women. The OR for a pregnancy weight gain below recommendations resulted in a negative relationship for normal BMI and lean women, but not for overweight and obese women based on the IOM recommendations, significant based on the recommended pregnancy weight gain for Chinese women. Of normal weight children, 56.6% were above the GWG based on IOM recommendations, but 26.97% of normal weight children were above the GWG based on Chinese recommendations. Conclusions A GWG above IOM recommendations might not be helpful for Chinese women. We need unified criteria to classify adult BMI and to expand the sample size to improve representation and to elucidate the relationship between GWG and related outcomes for developing a Chinese GWG recommendation.
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Affiliation(s)
- Shaoping Yang
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Anna Peng
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Sheng Wei
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wu
- Key Laboratory of Environment and Health, Ministry of Education & Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinzhu Zhao
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Yiming Zhang
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
| | - Jing Wang
- Maternal and Children Health Care Department of Districts of Wuhan, Wuhan, China
| | - Yuan Lu
- Maternal and Children Health Care Department of Districts of Wuhan, Wuhan, China
| | - Yuzhen Yu
- Maternal and Children Health Care Department of Districts of Wuhan, Wuhan, China
| | - Bin Zhang
- Department of Primary Guidance, Wuhan Women and Children Health Care Center, Wuhan, Hubei Province, 430015, China
- * E-mail:
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Hung TH, Hsieh TT. The effects of implementing the International Association of Diabetes and Pregnancy Study Groups criteria for diagnosing gestational diabetes on maternal and neonatal outcomes. PLoS One 2015; 10:e0122261. [PMID: 25756838 PMCID: PMC4355616 DOI: 10.1371/journal.pone.0122261] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 02/15/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommended a new strategy for the screening and diagnosis of gestational diabetes mellitus (GDM). However, no study has indicated that adopting the IADPSG recommendations improves perinatal outcomes. The objective of this study was to evaluate the effects of implementing the IADPSG criteria for diagnosing GDM on maternal and neonatal outcomes. METHODOLOGY/PRINCIPAL FINDINGS Previously, we used a two-step approach (a 1-h, 50-g glucose challenge test followed by a 3-h, 100-g glucose tolerance test when indicated) to screen for and diagnose GDM. In July 2011, we adopted the IADPSG recommendations in our routine obstetric care. In this study, we retrospectively compared the rates of various maternal and neonatal outcomes in all women who delivered after 24 weeks of gestation during the periods before (P1, between January 1, 2009 and December 31, 2010) and after (P2, between January 1, 2012 and December 31, 2013) the IADPSG criteria were implemented. Pregnancies complicated by multiple gestations, fetal chromosomal or structural anomalies, and pre-pregnancy diabetes mellitus were excluded. Our results showed that the incidence of GDM increased from 4.6% using the two-step method to 12.4% using the IADPSG criteria. Compared to the women in P1, the women in P2 experienced less weight gain during pregnancy, lower birth weights, shorter labor courses, and lower rates of macrosomia (<4000 g) and large-for-gestational age (LGA) infants. P2 was a significant independent factor against macrosomia (adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.90) and LGA (adjusted OR 0.74, 95% CI 0.61-0.89) after multivariable logistic regression analysis. CONCLUSIONS/SIGNIFICANCE The adoption of the IADPSG criteria for diagnosis of GDM was associated with significant reductions in maternal weight gain during pregnancy, birth weights, and the rates of macrosomia and LGA.
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Affiliation(s)
- Tai-Ho Hung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
- Department of Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - T’sang-T’ang Hsieh
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Taipei, Taipei, Taiwan
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Hedegaard M, Lidegaard Ø, Skovlund CW, Mørch LS, Hedegaard M. Perinatal outcomes following an earlier post-term labour induction policy: a historical cohort study. BJOG 2015; 122:1377-85. [PMID: 25690911 DOI: 10.1111/1471-0528.13299] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the changes in perinatal outcomes in children born from 37 weeks of gestation after implementation of a more proactive labour induction practice from 2009. DESIGN Register-based cohort study. SETTING Denmark, 2000-12. POPULATION Newborns from 37 weeks of gestation. METHODS Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index. MAIN OUTCOME MEASURES Perinatal outcomes. RESULTS A total of 770 926 infants were included. Labour induction from 37 weeks increased from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH < 7.0 decreased by 23%; odds ratio (OR) 0.77 (95% confidence interval 0.67-0.89), and the adjusted OR of Apgar score < 7 at 5 minutes was unchanged. The risk of admission to neonatal intensive care units increased by 56%; OR 1.56 (1.47-1.66), whereas the risk of neonatal deaths decreased by 44%; OR 0.56 (0.45-0.70). The risk of cerebral palsy was from 2000-02 to 2009-10 reduced by 26%; OR 0.74 (0.60-0.90). The proportion of infants born with fetal weight ≥ 4500 g decreased by one-third; OR 0.68 (0.65-0.71). However, the risk of shoulder dystocia increased by 32%; OR 1.32 (1.21-1.44), whereas the risk of peripheral nerve injuries was reduced by 43%; OR 0.57 (0.45-0.73). CONCLUSION The results suggest an overall improvement in perinatal outcomes as a result of a more proactive post-term labour induction practice.
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Affiliation(s)
- M Hedegaard
- Department of Gynaecology, Rigshospitalet, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - Ø Lidegaard
- Department of Gynaecology, Rigshospitalet, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - C W Skovlund
- Department of Gynaecology, Rigshospitalet, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - L S Mørch
- Department of Gynaecology, Rigshospitalet, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - M Hedegaard
- Department of Obstetrics, Rigshospitalet, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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Epidemiologic aspects of shoulder dystocia-related neurological birth injuries. Arch Gynecol Obstet 2014; 291:769-77. [DOI: 10.1007/s00404-014-3453-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/29/2014] [Indexed: 12/14/2022]
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