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Gu X, Huang P, Xu X, Zheng Z, Luo K, Xu Y, Jia Y, Zhou Y. Machine learning approach for the prediction of macrosomia. Vis Comput Ind Biomed Art 2024; 7:22. [PMID: 39190235 DOI: 10.1186/s42492-024-00172-9] [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: 01/15/2024] [Accepted: 07/31/2024] [Indexed: 08/28/2024] Open
Abstract
Fetal macrosomia is associated with maternal and newborn complications due to incorrect fetal weight estimation or inappropriate choice of delivery models. The early screening and evaluation of macrosomia in the third trimester can improve delivery outcomes and reduce complications. However, traditional clinical and ultrasound examinations face difficulties in obtaining accurate fetal measurements during the third trimester of pregnancy. This study aims to develop a comprehensive predictive model for detecting macrosomia using machine learning (ML) algorithms. The accuracy of macrosomia prediction using logistic regression, k-nearest neighbors, support vector machine, random forest (RF), XGBoost, and LightGBM algorithms was explored. Each approach was trained and validated using data from 3244 pregnant women at a hospital in southern China. The information gain method was employed to identify deterministic features associated with the occurrence of macrosomia. The performance of six ML algorithms based on the recall and area under the curve evaluation metrics were compared. To develop an efficient prediction model, two sets of experiments based on ultrasound examination records within 1-7 days and 8-14 days prior to delivery were conducted. The ensemble model, comprising the RF, XGBoost, and LightGBM algorithms, showed encouraging results. For each experimental group, the proposed ensemble model outperformed other ML approaches and the traditional Hadlock formula. The experimental results indicate that, with the most risk-relevant features, the ML algorithms presented in this study can predict macrosomia and assist obstetricians in selecting more appropriate delivery models.
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Affiliation(s)
- Xiaochen Gu
- Eye Hospital, Wenzhou Medical University, Wenzhou, Zheijang, 325027, China
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzen, Guangdong, 518058, China
- Marshall Laboratory of Biomedical Engineering, Shenzen, Guangdong, 518058, China
| | - Ping Huang
- Division of Ultrasound, Department of Medical Imaging, the University of Hong Kong-Shenzhen Hospital, Shenzen, Guangdong, 518058, China
| | - Xiaohua Xu
- Division of Ultrasound, Department of Medical Imaging, the University of Hong Kong-Shenzhen Hospital, Shenzen, Guangdong, 518058, China
| | - Zhicheng Zheng
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzen, Guangdong, 518058, China
- Marshall Laboratory of Biomedical Engineering, Shenzen, Guangdong, 518058, China
| | - Kaiju Luo
- Ultrasound Department, the First Affiliated Hospital of Shenzhen University, Second People's Hospital, Shenzen, Guangdong, China, 518058
| | - Yujie Xu
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzen, Guangdong, 518058, China
- Marshall Laboratory of Biomedical Engineering, Shenzen, Guangdong, 518058, China
| | - Yizhen Jia
- Core Laboratory, the University of Hong Kong-Shenzhen Hospital, Shenzen, Guangdong, 518058, China.
| | - Yongjin Zhou
- School of Biomedical Engineering, Medical School, Shenzhen University, Shenzen, Guangdong, 518058, China.
- Marshall Laboratory of Biomedical Engineering, Shenzen, Guangdong, 518058, China.
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Sousa KS, Leite HV, Corrêa MD, Sousa MS, Queiroz ALR. Prevalence of macrosomic newborn and maternal and neonatal complications in a high-risk maternity. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo48. [PMID: 38994466 PMCID: PMC11239214 DOI: 10.61622/rbgo/2024rbgo48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/07/2024] [Indexed: 07/13/2024] Open
Abstract
Objective Evaluate the prevalence of macrosomic newborns (birth weight above 4000 grams) in a high-risk maternity from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated outcomes, comparing newborns weighing 4000-4500 grams and those weighing above 4500 grams. Methods This is an observational study, case-control type, carried out by searching for data in hospital's own system and clinical records. The criteria for inclusion in the study were all patients monitored at the service who had newborns with birth weight equal than or greater than 4000 grams in the period from January 2014 to December 2019, being subsequently divided into two subgroups (newborns with 4000 to 4500 grams and newborns above 4500 grams). After being collected, the variables were transcribed into a database, arranged in frequency tables. For treatment and statistical analysis of the data, Excel and R software were used. This tool was used to create graphs and tables that helped in the interpretation of the results. The statistical analysis of the variables collected included both simple descriptive analyzes as well as inferential statistics, with univariate, bivariate and multivariate analysis. Results From 2014 to 2019, 3.3% of deliveries were macrosomic newborns. The average gestational age in the birth was 39.4 weeks. The most common mode of delivery (65%) was cesarean section. Diabetes mellitus was present in 30% of the deliveries studied and glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented and there was shoulder dystocia in 21% of the cases. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common. Conclusion Birth weight above 4000 grams had a statistically significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significant associated with neonatal complications, the lower, the greater the risk. Thus, macrosomia is strongly linked to complications, especially neonatal complications.
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Affiliation(s)
- Kellen Silva Sousa
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Henrique Vitor Leite
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Mário Dias Corrêa
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Matheus Silva Sousa
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Anna Luíza Rocha Queiroz
- Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Badr DA, Carlin A, Boulvain M, Kadji C, Cannie MM, Jani JC, Gucciardo L. A simulation study to assess the potential benefits of MRI-based fetal weight estimation as a second-line test for suspected macrosomia. Eur J Obstet Gynecol Reprod Biol 2024; 297:126-131. [PMID: 38615575 DOI: 10.1016/j.ejogrb.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To simulate the outcomes of Boulvain's trial by using magnetic resonance imaging (MRI) for estimated fetal weight (EFW) as a second-line confirmatory imaging. STUDY DESIGN Data derived from the Boulvain's trial and the study PREMACRO (PREdict MACROsomia) were used to simulate a 1000-patient trial. Boulvain's trial compared induction of labor (IOL) to expectant management in suspected macrosomia, whereas PREMACRO study compared the performance of ultrasound-EFW (US-EFW) and MRI-EFW in the prediction of birthweight. The primary outcome was the incidence of significant shoulder dystocia (SD). Cesarean delivery (CD), hyperbilirubinemia (HB), and IOL at < 39 weeks of gestation (WG) were selected as secondary outcomes. A subgroup analysis of the Boulvain's trial was performed to estimate the incidence of the primary and secondary outcomes in the true positive and false positive groups for the two study arms. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) for the prediction of macrosomia by MRI-EFW at 36 WG were calculated, and a decision tree was constructed for each outcome. RESULTS The PPV of US-EFW for the prediction of macrosomia in the PREMACRO trial was 56.3 %. MRI-EFW was superior to US-EFW as a predictive tool resulting in lower rates of induction for false-positive cases. Repeating Boulvain's trial using MRI-EFW as a second-line test would result in similar rates of SD (relative risk [RR]:0.36), CD (RR:0.84), and neonatal HB (RR:2.6), as in the original trial. Increasing the sensitivity and specificity of MRI-EFW resulted in a similar relative risk for SD as in Boulvain's trial, but with reduced rates of IOL < 39 WG, and improved the RR of CD in favor of IOL. We found an inverse relationship between IOL rate and incidence of SD for both US-EFW and MRI-EFW, although overall rates of IOL, CD, and neonatal HB would be lower with MRI-derived estimates of fetal weight. CONCLUSION The superior accuracy of MRI-EFW over US-EFW for the diagnosis of macrosomia could result in lower rates of IOL without compromising the relative advantages of the intervention but fails to demonstrate a significant benefit to justify a replication of the original trial using MRI-EFW as a second-line test.
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Affiliation(s)
- Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Michel Boulvain
- Department of Obstetrics and Gynecology, UZ Brussels, Vrije Universiteit Brussel, Brussels Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium; Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Leonardo Gucciardo
- Department of Obstetrics and Gynecology, UZ Brussels, Vrije Universiteit Brussel, Brussels Belgium
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Ewington LJ, Hugh O, Butler E, Quenby S, Gardosi J. Accuracy of antenatal ultrasound in predicting large-for-gestational-age babies: population-based cohort study. Am J Obstet Gynecol 2024:S0002-9378(24)00578-7. [PMID: 38723984 DOI: 10.1016/j.ajog.2024.04.052] [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: 02/22/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Pregnancies with large-for-gestational-age fetuses are at increased risk of adverse maternal and neonatal outcomes. There is uncertainty about how to manage birth in such pregnancies. Current guidelines recommend a discussion with women of the pros and cons of options, including expectant management, induction of labor, and cesarean delivery. For women to make an informed decision about birth, antenatal detection of large for gestational age is essential. OBJECTIVE To investigate the ability of antenatal ultrasound scans to predict large for gestational age at birth. STUDY DESIGN In this retrospective cohort study, we analyzed data from a routinely collected database from the West Midlands, United Kingdom. We included pregnancies that had an antenatal ultrasound-estimated fetal weight between 35+0 and 38+0 weeks gestation for any indication and a subgroup where the reason for the scan was that the fetus was suspected to be big. Large for gestational age was defined as >90th customized GROW percentile for estimated fetal weight as well as neonatal weight. In addition, we tested the performance of an uncustomized standard, with Hadlock fetal weight >90th percentile and neonatal weight >4 kg. We calculated diagnostic characteristics for the whole population and groups with different maternal body mass indexes. RESULTS The study cohort consisted of 26,527 pregnancies, which, on average, had a scan at 36+4 weeks gestation and delivered 20 days later at a median of 39+3 weeks (interquartile range 15). In total, 2241 (8.4%) of neonates were large for gestational age by customized percentiles, of which 1459 (65.1%) had a scan estimated fetal weight >90th percentile, with a false positive rate of 8.6% and a positive predictive value of 41.0%. In the subgroup of 912 (3.4%) pregnancies scanned for a suspected large fetus, 293 (32.1%) babies were large for gestational age at birth, giving a positive predictive value of 50.3%, with a sensitivity of 77.1% and false positive rate of 36.0%. When comparing subgroups from low (<18.5 kg/m2) to high body mass index (>30 kg/m2), sensitivity increased from 55.6% to 67.8%, false positive rate from 5.2% to 11.5%, and positive predictive value from 32.1% to 42.3%. A total of 2585 (9.7%) babies were macrosomic (birthweight >4 kg), and of these, 1058 (40.9%) were large for gestational age (>90th percentile) antenatally by Hadlock's growth standard, with a false positive rate of 4.9% and a positive predictive value 41.0%. Analysis within subgroups showed better performance by customized than uncustomized standards for low body mass index (<18.5; diagnostic odds ratio, 23.0 vs 6.4) and high body mass index (>30; diagnostic odds ratio, 16.2 vs 8.8). CONCLUSION Late third-trimester ultrasound estimation of fetal weight for any indication has a good ability to identify and predict large for gestational age at birth and improves with the use of a customized standard. The detection rate is better when an ultrasound is performed for a suspected large fetus but at the risk of a higher false positive diagnosis. Our results provide information for women and clinicians to aid antenatal decision-making about the birth of a fetus suspected of being large for gestational age.
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Affiliation(s)
- Lauren J Ewington
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, United Kingdom
| | - Oliver Hugh
- Perinatal Institute, Birmingham, United Kingdom
| | | | - Siobhan Quenby
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, United Kingdom; University Hospitals Coventry and Warwickshire, United Kingdom
| | - Jason Gardosi
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, United Kingdom; Perinatal Institute, Birmingham, United Kingdom.
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Mazzone E, Kadji C, Cannie MM, Badr DA, Jani JC. Prediction of large-for-gestational age at 36 weeks' gestation: two-dimensional ultrasound vs three-dimensional ultrasound vs magnetic resonance imaging. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:489-496. [PMID: 37725758 DOI: 10.1002/uog.27485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/05/2023] [Accepted: 09/08/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare the performance of two-dimensional ultrasound (2D-US), three-dimensional ultrasound (3D-US) and magnetic resonance imaging (MRI) at 36 weeks' gestation in predicting the delivery of a large-for-gestational-age (LGA) neonate, defined as birth weight ≥ 95th percentile, in patients at high and low risk for macrosomia. METHODS This was a secondary analysis of a prospective observational study conducted between January 2017 and February 2019. Women with a singleton pregnancy at 36 weeks' gestation underwent 2D-US, 3D-US and MRI within 15 min for estimation of fetal weight. Weight estimations and birth weight were plotted on a growth curve to obtain percentiles for comparison. Participants were considered high risk if they had at least one of the following risk factors: diabetes mellitus, estimated fetal weight ≥ 90th percentile at the routine third-trimester ultrasound examination, obesity (prepregnancy body mass index ≥ 30 kg/m2) or excessive weight gain during pregnancy. The outcome was the diagnostic performance of each modality in the prediction of birth weight ≥ 95th percentile, expressed as the area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity and positive and negative predictive values. RESULTS A total of 965 women were included, of whom 533 (55.23%) were high risk and 432 (44.77%) were low risk. In the low-risk group, the AUCs for birth weight ≥ 95th percentile were 0.982 for MRI, 0.964 for 2D-US and 0.962 for 3D-US; pairwise comparisons were non-significant. In the high-risk group, the AUCs were 0.959 for MRI, 0.909 for 2D-US and 0.894 for 3D-US. A statistically significant difference was noted between MRI and both 2D-US (P = 0.002) and 3D-US (P = 0.002), but not between 2D-US and 3D-US (P = 0.503). In the high-risk group, MRI had the highest sensitivity (65.79%) compared with 2D-US (36.84%, P = 0.002) and 3D-US (21.05%, P < 0.001), whereas 3D-US had the highest specificity (98.99%) compared with 2D-US (96.77%, P = 0.005) and MRI (96.97%, P = 0.004). CONCLUSIONS At 36 weeks' gestation, MRI has better performance compared with 2D-US and 3D-US in predicting birth weight ≥ 95th percentile in patients at high risk for macrosomia, whereas the performance of 2D-US and 3D-US is comparable. For low-risk patients, the three modalities perform similarly. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Mazzone
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - C Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - D A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Sarosi E, Gatta LA, Berman DR, Kuller JA. A Rational and Standardized Prenatal Examination. Obstet Gynecol Surv 2023; 78:358-368. [PMID: 37322997 DOI: 10.1097/ogx.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Importance As prenatal care is in transition after the COVID-19 pandemic, reviewing fundamental physical examination approaches is necessary for providers examining obstetrical patients. Objective The objective of this review is 3-fold: (1) convey why the age of telemedicine necessitates reconsideration of the standardized physical examination in routine prenatal care; (2) identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, pelvis, and fetal growth; and (3) propose an evidence-based prenatal physical examination. Evidence Acquisition A comprehensive literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines. Results We conclude that an evidence-based prenatal examination for asymptomatic patients includes the following maneuvers: inspection and palpation for thyromegaly and cervical lymphadenopathy, cardiac auscultation, fundal height measurement, and a pelvic examination for purposes including testing for gonorrhea and chlamydia, assessing pelvimetry, and assessing cervical dilation later in the pregnancy, intrapartum, or in the setting of ultrasonogram-detected prelabor preterm cervical shortening. Conclusions and Relevance Although not true of all physical examination maneuvers, this article demonstrates that there are maneuvers that continue to play important screening roles in asymptomatic patients. With the increase in virtual visits and fewer in-person prenatal appointments, the rational basis for maneuvers recommended in this review should inform decision making around the prenatal examination performed.
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Affiliation(s)
- Ellery Sarosi
- Medical Student, University of Michigan Medical School, Ann Arbor, MI
| | - Luke A Gatta
- Fellow, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Deborah R Berman
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI
| | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
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Boulvain M, Thornton JG. Induction of labour at or near term for suspected fetal macrosomia. Cochrane Database Syst Rev 2023; 3:CD000938. [PMID: 36884238 PMCID: PMC9995561 DOI: 10.1002/14651858.cd000938.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section. The baby is also at increased risk of shoulder dystocia and trauma, in particular fractures and brachial plexus injury. Induction of labour may reduce these risks by decreasing the birthweight, but may also lead to longer labours and an increased risk of caesarean section. OBJECTIVES To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on the way of giving birth and maternal or perinatal morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), contacted trial authors and searched reference lists of retrieved studies. SELECTION CRITERIA Randomised trials of induction of labour for suspected fetal macrosomia. DATA COLLECTION AND ANALYSIS Review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We contacted study authors for additional information. For key outcomes the quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included four trials, involving 1190 women. It was not possible to blind women and staff to the intervention, but for other 'Risk of bias' domains these studies were assessed as being at low or unclear risk of bias. Compared to expectant management, there was no clear effect of induction of labour for suspected macrosomia on the risk of caesarean section (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.76 to 1.09; 1190 women; four trials, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; 1190 women; four trials, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 1190 women; four trials, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; 1190 women; four studies, high-quality evidence) were reduced in the induction of labour group. There were no clear differences between groups for brachial plexus injury (two events were reported in the control group in one trial, low-quality evidence). There was no strong evidence of any difference between groups for measures of neonatal asphyxia; low five-minute infant Apgar scores (less than seven) or low arterial cord blood pH (RR 1.51, 95% CI 0.25 to 9.02; 858 infants; two trials, low-quality evidence; and, RR 1.01, 95% CI 0.46 to 2.22; 818 infants; one trial, moderate-quality evidence, respectively). Mean birthweight was lower in the induction group, but there was considerable heterogeneity between studies for this outcome (mean difference (MD) -178.03 g, 95% CI -315.26 to -40.81; 1190 infants; four studies; I2 = 89%). For outcomes assessed using GRADE, we based our downgrading decisions on high risk of bias from lack of blinding and imprecision of effect estimates. AUTHORS' CONCLUSIONS Induction of labour for suspected fetal macrosomia has not been shown to alter the risk of brachial plexus injury, but the power of the included studies to show a difference for such a rare event is limited. Also antenatal estimates of fetal weight are often inaccurate so many women may be worried unnecessarily, and many inductions may not be needed. Nevertheless, induction of labour for suspected fetal macrosomia results in a lower mean birthweight, and fewer birth fractures and shoulder dystocia. The observation of increased use of phototherapy in the largest trial, should also be kept in mind. Findings from trials included in the review suggest that to prevent one fracture it would be necessary to induce labour in 60 women. Since induction of labour does not appear to alter the rate of caesarean delivery or instrumental delivery, it is likely to be popular with many women. In settings where obstetricians can be reasonably confident about their scan assessment of fetal weight, the advantages and disadvantages of induction at or near term for fetuses suspected of being macrosomic should be discussed with parents. Although some parents and doctors may feel the evidence already justifies induction, others may justifiably disagree. Further trials of induction shortly before term for suspected fetal macrosomia are needed. Such trials should concentrate on refining the optimum gestation of induction, and improving the accuracy of the diagnosis of macrosomia.
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Affiliation(s)
- Michel Boulvain
- Department of Gynecology and Obstetrics, University of Geneva/GHOL-Nyon Hospital, NYON, Switzerland
| | - Jim G Thornton
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK
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Abdelwahab M, Frey HA, Lynch CD, Klebanoff MA, Thung SF, Costantine MM, Landon MB, Venkatesh KK. Association between Diabetes in Pregnancy and Shoulder Dystocia by Infant Birth Weight in an Era of Cesarean Delivery for Suspected Macrosomia. Am J Perinatol 2023. [PMID: 36848935 DOI: 10.1055/s-0043-1764206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE We estimated the association between diabetes and shoulder dystocia by infant birth weight subgroups (<4,000, 4,000-4,500, and >4,500 g) in an era of prophylactic cesarean delivery for suspected macrosomia. STUDY DESIGN A secondary analysis from the National Institute of Child Health and Human Development U.S. Consortium for Safe Labor of deliveries at ≥24 weeks with a nonanomalous, singleton fetus with vertex presentation undergoing a trial of labor. The exposure was either pregestational or gestational diabetes compared with no diabetes. The primary outcome was shoulder dystocia and secondarily, birth trauma with a shoulder dystocia. We calculated adjusted risk ratios (aRRs) with modified Poison's regression between diabetes and shoulder dystocia and the number needed to treat (NNT) to prevent a shoulder dystocia with cesarean delivery. RESULTS Among 167,589 assessed deliveries (6% with diabetes), pregnant individuals with diabetes had a higher risk of shoulder dystocia at birth weight <4,000 g (aRR: 1.95; 95% confidence interval [CI]: 1.66-2.31) and 4,000 to 4,500 g (aRR: 1.57; 95% CI: 1.24-1.99), albeit not significantly at birth weight >4,500 g (aRR: 1.26; 95% CI: 0.87-1.82) versus those without diabetes. The risk of birth trauma with shoulder dystocia was higher with diabetes (aRR: 2.29; 95% CI: 1.54-3.45). The NNT to prevent a shoulder dystocia with diabetes was 11 and 6 at ≥4,000 and >4,500 g, versus without diabetes, 17 and 8 at ≥4,000 and >4,500 g, respectively. CONCLUSION Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered. Guidelines providing the option of cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights. KEY POINTS · >Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered.. · Cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights.. · These findings can inform delivery planning for providers and pregnant individuals with diabetes..
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Affiliation(s)
- Mahmoud Abdelwahab
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Heather A Frey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Courtney D Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.,Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Mark A Klebanoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.,Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Stephen F Thung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Maged M Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Mark B Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Kartik K Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
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Dall'Asta A, Ramirez Zegarra R, Corno E, Mappa I, Lu JLA, Di Pasquo E, Morganelli G, Abou‐Dakn M, Germano C, Attini R, Masturzo B, Rizzo G, Ghi T. Role of fetal head-circumference-to-maternal-height ratio in predicting Cesarean section for labor dystocia: prospective multicenter study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:93-98. [PMID: 35767709 PMCID: PMC10107777 DOI: 10.1002/uog.24981] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the relationship between the fetal head-circumference-to-maternal-height (HC/MH) ratio measured shortly before delivery and the occurrence of Cesarean section (CS) for labor dystocia. METHODS This was a multicenter prospective cohort study involving four tertiary maternity hospitals. An unselected cohort of women with a singleton fetus in cephalic presentation, at a gestational age beyond 36 + 0 weeks and without any contraindication for vaginal delivery, was enrolled between September 2020 and November 2021. The MH and fetal HC were measured on admission of the patient to the labor ward. The primary outcome of the study was the performance of the HC/MH ratio in the prediction of CS for labor dystocia. Women who underwent CS for any indication other than failed labor progression, including fetal distress, were excluded from the final analysis. RESULTS A total of 783 women were included in the study. Vaginal delivery occurred in 744 (95.0%) women and CS for labor dystocia in 39 (5.0%). CS for labor dystocia was associated with shorter MH (mean ± SD, 160.4 ± 6.6 vs 164.5 ± 6.3 cm; P < 0.001), larger fetal HC (339.6 ± 9.5 vs 330.7 ± 13.0 mm; P < 0.001) and a higher HC/MH ratio (2.12 ± 0.11 vs 2.01 ± 0.10; P < 0.001) compared with vaginal delivery. Multivariate logistic regression analysis showed that the HC/MH ratio was associated independently with CS for labor dystocia (adjusted odds ratio, 2.65 (95% CI, 1.85-3.79); P < 0.001). The HC/MH ratio had an area under the receiver-operating-characteristics curve of 0.77 and an optimal cut-off value for discriminating between vaginal delivery and CS for labor dystocia of 2.09, which was associated with a sensitivity of 0.62 (95% CI, 0.45-0.77), specificity of 0.79 (95% CI, 0.76-0.82), positive predictive value of 0.13 (95% CI, 0.09-0.19) and negative predictive value of 0.98 (95% CI, 0.96-0.99). CONCLUSIONS In a large cohort of unselected pregnancies, the HC/MH ratio performed better than did fetal HC and MH alone in identifying those cases that will undergo CS for labor dystocia, albeit with moderate predictive value. The HC/MH ratio could assist in the evaluation of women at risk for CS for labor dystocia. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- A. Dall'Asta
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
| | - R. Ramirez Zegarra
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
- Department of Obstetrics and GynecologySt Joseph KrankenhausBerlinGermany
| | - E. Corno
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
| | - I. Mappa
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
| | - J. L. A. Lu
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
| | - E. Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
| | - G. Morganelli
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
| | - M. Abou‐Dakn
- Department of Obstetrics and GynecologySt Joseph KrankenhausBerlinGermany
| | - C. Germano
- Department of Obstetrics and Gynecology, Sant'Anna HospitalUniversity of TurinTurinItaly
| | - R. Attini
- Department of Obstetrics and Gynecology, Sant'Anna HospitalUniversity of TurinTurinItaly
| | - B. Masturzo
- Department of Obstetrics and Gynecology, Sant'Anna HospitalUniversity of TurinTurinItaly
| | - G. Rizzo
- Department of Obstetrics and Gynecology, Fondazione Policlinico Tor VergataUniversity of Rome Tor VergataRomeItaly
| | - T. Ghi
- Department of Medicine and Surgery, Obstetrics and Gynecology UnitUniversity of ParmaParmaItaly
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Guideline No. 432a: Cervical Ripening and Induction of Labour - General Information. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:35-44.e1. [PMID: 36725128 DOI: 10.1016/j.jogc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This guideline presents evidence and recommendations for cervical ripening and induction of labour. It aims to provide information to birth attendants and pregnant individuals on optimal perinatal care while avoiding unnecessary obstetrical intervention. TARGET POPULATION All pregnant patients. BENEFITS, HARMS, AND COSTS Consistent interprofessional use of the guideline, appropriate equipment, and trained professional staff enhance safe intrapartum care. Pregnant individuals and their support person(s) should be informed of the benefits and risks of induction of labour. EVIDENCE Literature published to March 2022 was reviewed. PubMed, CINAHL, and the Cochrane Library were used to search for systematic reviews, randomized controlled trials, and observational studies on cervical ripening and induction of labour. Grey (unpublished) literature was identified by searching the websites of health technology assessment and health technology related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All providers of obstetrical care. RECOMMANDATIONS
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11
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Robinson D, Campbell K, Hobson SR, MacDonald WK, Sawchuck D, Wagner B. Directive clinique n o 432a : Maturation cervicale et déclenchement artificiel du travail - Information générale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:45-55.e1. [PMID: 36725130 DOI: 10.1016/j.jogc.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIF Présenter des données probantes et des recommandations sur la maturation cervicale et le déclenchement artificiel du travail. Fournir de l'information aux professionnels accoucheurs et aux personnes enceintes sur les soins périnataux optimaux et la prévention des interventions obstétricales inutiles. POPULATION CIBLE Toutes les patientes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en application interprofessionnelle et cohérente de la présente directive, l'équipement adéquat et le personnel compétent améliorent la sécurité des soins per partum. Les personnes enceintes et leurs personnes de soutien doivent être informées des risques et bénéfices du déclenchement artificiel du travail. DONNéES PROBANTES: La littérature publiée jusqu'en mars 2022 a été passée en revue. Une recherche a été effectuée dans les bases de données PubMed, CINAHL et Cochrane Library pour répertorier des revues systématiques, des essais cliniques randomisés et des études observationnelles sur la maturation cervicale et le déclenchement artificiel du travail. La littérature grise (non publiée) a été obtenue à l'aide de recherches menées dans des sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, des registres d'essais cliniques et des sites Web de sociétés de spécialité médicale nationales et internationales. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les fournisseurs de soins obstétricaux. RECOMMANDATIONS
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12
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Kiefer MK, Finneran MM, Ware CA, Foy P, Thung SF, Gabbe SG, Landon MB, Grobman WA, Venkatesh KK. Prediction of large-for-gestational-age infant by fetal growth charts and hemoglobin A1c level in pregnancy complicated by pregestational diabetes. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:751-758. [PMID: 36099480 PMCID: PMC10107738 DOI: 10.1002/uog.26071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/19/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To compare the ability of three fetal growth charts (Fetal Medicine Foundation (FMF), Hadlock and National Institutes of Child Health and Human Development (NICHD) race/ethnicity-specific) to predict large-for-gestational age (LGA) at birth in pregnant individuals with pregestational diabetes, and to determine whether inclusion of hemoglobin A1c (HbA1c) level improves the predictive performance of the growth charts. METHODS This was a retrospective analysis of individuals with Type-1 or Type-2 diabetes with a singleton pregnancy that resulted in a non-anomalous live birth. Fetal biometry was performed between 28 + 0 and 36 + 6 weeks of gestation. The primary exposure was suspected LGA, defined as estimated fetal weight ≥ 90th percentile using the Hadlock (Formula C), FMF and NICHD growth charts. The primary outcome was LGA at birth, defined as birth weight ≥ 90th percentile, using 2017 USA natality reference data. The performance of the three growth charts to predict LGA at birth, alone and in combination with HbA1c as a continuous measure, was assessed using the area under the receiver-operating-characteristics curve (AUC), sensitivity, specificity, positive predictive value and negative predictive value. RESULTS Of 358 assessed pregnant individuals with pregestational diabetes (34% with Type 1 and 66% with Type 2), 147 (41%) had a LGA infant at birth. Suspected LGA was identified in 123 (34.4%) by the Hadlock, 152 (42.5%) by the FMF and 152 (42.5%) by the NICHD growth chart. The FMF growth chart had the highest sensitivity (77% vs 69% (NICHD) vs 63% (Hadlock)) and the Hadlock growth chart had the highest specificity (86% vs 76% (NICHD) and 82% (FMF)) for predicting LGA at birth. The FMF growth chart had a significantly higher AUC (0.79 (95% CI, 0.74-0.84)) for LGA at birth compared with the NICHD (AUC, 0.72 (95% CI, 0.68-0.77); P < 0.001) and Hadlock (AUC, 0.75 (95% CI, 0.70-0.79); P < 0.01) growth charts. Prediction of LGA improved for all three growth charts with the inclusion of HbA1c measurement in comparison to each growth chart alone (P < 0.001 for all); the FMF growth chart remained more predictive of LGA at birth (AUC, 0.85 (95% CI, 0.81-0.90)) compared with the NICHD (AUC, 0.79 (95% CI, 0.73-0.84)) and Hadlock (AUC, 0.81 (95% CI, 0.76-0.86)) growth charts. CONCLUSIONS The FMF fetal growth chart had the best predictive performance for LGA at birth in comparison with the Hadlock and NICHD race/ethnicity-specific growth charts in pregnant individuals with pregestational diabetes. Inclusion of HbA1c improved further the prediction of LGA for all three charts. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M. K. Kiefer
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - M. M. Finneran
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineMedical University of South CarolinaCharlestonSCUSA
| | - C. A. Ware
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - P. Foy
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - S. F. Thung
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - S. G. Gabbe
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - M. B. Landon
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - W. A. Grobman
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
| | - K. K. Venkatesh
- Department of Obstetrics and Gynecology, Division of Maternal–Fetal MedicineThe Ohio State UniversityColumbusOHUSA
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13
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Analytical Comparison of Risk Prediction Models for the Onset of Macrosomia Based on Three Statistical Methods. DISEASE MARKERS 2022; 2022:9073043. [PMID: 36124028 PMCID: PMC9482546 DOI: 10.1155/2022/9073043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
Abstract
Background and Purpose. Fetal overgrowth can pose a serious threat to the safety of a mother and child. Early identification of high-risk pregnant women and timely pregnancy intervention and guidance are of great value in preventing the development of giant babies and improving adverse maternal and infant outcomes. The current clinical methods for predicting macrosomia mainly rely on obstetric examination and imaging, but their accuracy is controversial. And there is no accepted method for accurately predicting macrosomia. We investigated the risk factors influencing the occurrence of macrosomia and established a prediction model for the occurrence of macrosomia to provide a reference basis for interventions to prevent macrosomia. Method. A retrospective selection of 93 women who were hospitalized in our hospital from March 2019 to May 2022 with a singleton pregnancy and delivered at term with macrosomia were the study group. And 356 women who delivered a normal size baby during the same period were the control group. The variables that were associated with the onset of macrosomia were screened from maternal medical records. Logistic regression models, random forest, and CART decision tree models were developed using the screened variables as input variables and whether they were macrosomia as outcome variables, respectively. The performance of the three models was evaluated by accuracy, precision, recall, F1 score, and receiver operating characteristic curve (ROC). Result. The risk prediction models for the onset of macrosomia, logistic regression model, random forest model, and decision tree, were successfully developed, with accuracies of 0.904, 1.000, and 0.901 in the training set and 0.926, 0.582, and 0.852 in the validation set, respectively. The AUC in the training set were 0.898, 1.000, and 0.789, and in the validation set were 0.906, 0.913, and 0.731, respectively. In general, the logistic regression model has the highest diagnostic efficiency, followed by the random forest model. Conclusion. Logistic regression models have high application value in the assessment of predicting the risk of macrosomia, and it is suggested that the advantages of logistic regression models and random forest models should be combined in future studies and applications to make them work better in the prediction of the risk of macrosomia.
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14
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Amgalan A, Kapse K, Krishnamurthy D, Andersen NR, Izem R, Baschat A, Quistorff J, Gimovsky AC, Ahmadzia HK, Limperopoulos C, Andescavage NN. Measuring intrauterine growth in healthy pregnancies using quantitative magnetic resonance imaging. J Perinatol 2022; 42:860-865. [PMID: 35194161 PMCID: PMC9380865 DOI: 10.1038/s41372-022-01340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/04/2021] [Accepted: 02/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The aim of this study was to determine in utero fetal-placental growth patterns using in vivo three-dimensional (3D) quantitative magnetic resonance imaging (qMRI). STUDY DESIGN Healthy women with singleton pregnancies underwent fetal MRI to measure fetal body, placenta, and amniotic space volumes. The fetal-placental ratio (FPR) was derived using 3D fetal body and placental volumes (PV). Descriptive statistics were used to describe the association of each measurement with increasing gestational age (GA) at MRI. RESULTS Fifty-eight (58) women underwent fetal MRI between 16 and 38 completed weeks gestation (mean = 28.12 ± 6.33). PV and FPR varied linearly with GA at MRI (rPV,GA = 0.83, rFPR,GA = 0.89, p value < 0.001). Fetal volume varied non-linearly with GA (p value < 0.01). CONCLUSIONS We describe in-utero growth trajectories of fetal-placental volumes in healthy pregnancies using qMRI. Understanding healthy in utero development can establish normative benchmarks where departures from normal may identify early in utero placental failure prior to the onset of fetal harm.
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Affiliation(s)
- Ariunzaya Amgalan
- School of Medicine, Georgetown University, 3900 Reservoir Road, NW, Washington, DC, 20057, USA
| | - Kushal Kapse
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Dhineshvikram Krishnamurthy
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Nicole R Andersen
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Rima Izem
- Division of Biostatistics & Study Methodology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Ahmet Baschat
- Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins Hospital, Baltimore, MD, 21287, USA
| | - Jessica Quistorff
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
| | - Alexis C Gimovsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, George Washington University, Washington, DC, 20037, USA
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, George Washington University, Washington, DC, 20037, USA
| | - Catherine Limperopoulos
- Division of Diagnostic Imaging & Radiology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA. .,Department of Pediatrics, George Washington University, Washington, DC, 20037, USA.
| | - Nickie N Andescavage
- Department of Pediatrics, George Washington University, Washington, DC, 20037, USA.,Division of Neonatology, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC, 20010, USA
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15
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Du J, Zhang X, Chai S, Zhao X, Sun J, Yuan N, Yu X, Zhang Q. Nomogram-based risk prediction of macrosomia: a case-control study. BMC Pregnancy Childbirth 2022; 22:392. [PMID: 35513792 PMCID: PMC9074352 DOI: 10.1186/s12884-022-04706-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 04/22/2022] [Indexed: 12/20/2022] Open
Abstract
Background Macrosomia is closely associated with poor maternal and fetal outcome. But there is short of studies on the risk of macrosomia in early pregnancy. The purpose of this study is to establish a nomogram for predicting macrosomia in the first trimester. Methods A case-control study involving 1549 pregnant women was performed. According to the birth weight of newborn, the subjects were divided into macrosomia group and non-macrosomia group. The risk factors for macrosomia in early pregnancy were analyzed by multivariate logistic regression. A nomogram was used to predict the risk of macrosomia. Results The prevalence of macrosomia was 6.13% (95/1549) in our hospital. Multivariate logistic regression analysis showed that prepregnancy overweight (OR: 2.13 95% CI: 1.18–3.83)/obesity (OR: 3.54, 95% CI: 1.56–8.04), multiparity (OR:1.88, 95% CI: 1.16–3.04), the history of macrosomia (OR: 36.97, 95% CI: 19.90–68.67), the history of GDM/DM (OR: 2.29, 95% CI: 1.31–3.98), the high levels of HbA1c (OR: 1.76, 95% CI: 1.00–3.10) and TC (OR: 1.36, 95% CI: 1.00–1.84) in the first trimester were the risk factors of macrosomia. The area under ROC (the receiver operating characteristic) curve of the nomogram model was 0.807 (95% CI: 0.755–0.859). The sensitivity and specificity of the model were 0.716 and 0.777, respectively. Conclusion The nomogram model provides an effective mothed for clinicians to predict macrosomia in the first trimester.
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Affiliation(s)
- Jing Du
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
| | - Xiaomei Zhang
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China.
| | - Sanbao Chai
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
| | - Xin Zhao
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
| | - Jianbin Sun
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
| | - Ning Yuan
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
| | - Xiaofeng Yu
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
| | - Qiaoling Zhang
- Department of Endocrinology and metabolism, Peking University International Hospital, No. 1 Life Garden Road Zhongguancun Life Science Garden Changping District, Beijing, 102206, China
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Chen C, Yang M, Zheng W, Yang X, Chen Y, Dong T, Lv M, Xi F, Jiang Y, Ying X, Li W, Xu J, Zhao B, Luo Q. Magnetic Resonance Imaging-Based Nomogram to Antenatal Predict Cesarean Delivery for Cephalopelvic Disproportion in Primiparous Women. J Magn Reson Imaging 2022; 56:1145-1154. [PMID: 35302271 DOI: 10.1002/jmri.28164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Cephalopelvic disproportion (CPD)-related obstructed labor is associated with maternal and neonatal morbidity and mortality. Accurate prediction of whether a primiparous woman is at high risk of an unplanned cesarean delivery would be a major advance in obstetrics. PURPOSE To develop and validate a predictive model assessing the risk of cesarean delivery in primiparous women based on MRI findings. STUDY TYPE Prospective. POPULATION A total of 150 primiparous women with clinical findings suggestive of CPD. FIELD STRENGTH/SEQUENCE T1-weighted fast spin-echo sequences, single-shot fast spin-echo (SSFSE) T2-weighted sequences at 1.5 T. ASSESSMENT Pelvimetry and fetal biometry were assessed independently by two radiologists. A nomogram model combined that the clinical and MRI characteristics was constructed. STATISTICAL TESTS Univariable and multivariable logistic regression analyses were applied to select independent variables. Receiver operating characteristic (ROC) analysis was performed, and the discrimination of the model was assessed by the area under the curve (AUC). Calibration was assessed by calibration plots. Decision curve analysis was applied to evaluate the net clinical benefit. A P value below 0.05 was considered to be statistically significant. RESULTS In multivariable modeling, the maternal body mass index (BMI) before delivery, bilateral femoral head distance, obstetric conjugate, fetal head circumference, and fetal abdominal circumference was significantly associated with the likelihood of cesarean delivery. The discrimination calculated as the AUC was 0.838 (95% confidence interval [CI]: 0.774-0.902). The sensitivity and specificity of the nomogram model were 0.787 and 0.764, and the positive predictive and negative predictive values were 0.696 and 0.840, respectively. The model demonstrated satisfactory calibration (calibration slope = 0.945). Moreover, the decision curve analysis proved the superior net benefit of the model compared with each factor included. DATA CONCLUSION Our study might provide a nomogram model that could identify primiparous women at risk of cesarean delivery caused by CPD based on MRI measurements. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Cheng Chen
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengmeng Yang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Weizeng Zheng
- Department of Radiology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofu Yang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Chen
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian Dong
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Min Lv
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangfang Xi
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Jiang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xia Ying
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Li
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Xu
- Reproductive Medicine Center, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Baihui Zhao
- Department of Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
| | - Qiong Luo
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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Aboughalia H, Pathak P, Basavalingu D, Chapman T, Revzin MV, Sienas LE, Deutsch GH, Katz DS, Moshiri M. Imaging Review of Obstetric Sequelae of Maternal Diabetes Mellitus. Radiographics 2021; 42:302-319. [PMID: 34855544 DOI: 10.1148/rg.210164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diabetes mellitus, whether preexisting or gestational, poses significant risk to both the mother and the developing fetus. A myriad of potential fetal complications in the setting of diabetic pregnancies include, among others, congenital anomalies, delayed fetal lung maturity, macrosomia, and increased perinatal morbidity and mortality. Congenital anomalies most commonly involve the nervous, cardiovascular, genitourinary, and musculoskeletal systems. Delayed fetal lung maturity, probably secondary to hyperglycemia suppressing surfactant secretion, is a major determinant of perinatal morbidity and mortality. Besides the potential complications encountered during cesarean delivery in macrosomic fetuses, vaginal delivery is also associated with increased risks of shoulder dystocia, clavicular and humeral fractures, and brachial plexus palsy. Maternal complications are related to the increased risk of hypertensive diseases of pregnancy and associated preeclampsia and hemolysis, elevated liver function, and low platelets (HELLP) syndrome, as well as complications encountered at the time of delivery secondary to fetal macrosomia and cesarean delivery. Additional conditions encountered in the setting of maternal diabetes include polyhydramnios, placental thickening, and two-vessel umbilical cord, each of which is associated with adverse fetal and maternal outcomes including fetal growth restriction, preterm labor, placental abruption, and premature rupture of membranes. Imaging plays a vital role in the evaluation of the mother and the fetus and can provide invaluable information that can be used by maternal fetal medicine to manage this patient population effectively. The authors review the pathophysiologic alterations induced by diabetes in pregnancy, discuss the imaging spectrum of diabetic embryopathy, and provide a detailed review of potential associated maternal complications. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hassan Aboughalia
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Priya Pathak
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Deepashri Basavalingu
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Teresa Chapman
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Margarita V Revzin
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Laura E Sienas
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Gail H Deutsch
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (H.A., P.P., D.B., T.C.) and Laboratory Medicine and Pathology (G.H.D.), University of Washington, 1959 NE Pacific St, Seattle, WA 98195; Departments of Radiology (T.C.) and Laboratory Medicine and Pathology (G.H.D.), Seattle Children's Hospital, Seattle, Wash; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Conn (M.V.R.); Departments of Obstetrics and Gynecology (L.E.S.) and Radiology (M.M.), University of Washington Medical Center, Seattle, Wash; and Department of Radiology, NYU Langone Hospital-Long Island and NYU Long Island School of Medicine, Mineola, NY (D.S.K.)
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Dreisbach C. Reimagining and Contextualizing Fetal Weight Estimation. MCN Am J Matern Child Nurs 2021; 46:368. [PMID: 34653039 DOI: 10.1097/nmc.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Caitlin Dreisbach
- Dr. Caitlin Dreisbach is a former labor and delivery nurse and currently a Postdoctoral Research Scientist at the Data Science Institute, Columbia University, New York, NY. Dr. Dreisbach can be reached via email at
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MacDonald TM, Robinson AJ, Hiscock RJ, Hui L, Dane KM, Middleton AL, Kennedy LM, Tong S, Walker SP. Accelerated fetal growth velocity across the third trimester is associated with increased shoulder dystocia risk among fetuses who are not large-for-gestational-age: A prospective observational cohort study. PLoS One 2021; 16:e0258634. [PMID: 34669758 PMCID: PMC8528331 DOI: 10.1371/journal.pone.0258634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate whether fetuses with accelerated third trimester growth velocity are at increased risk of shoulder dystocia, even when they are not large-for-gestational-age (LGA; estimated fetal weight (EFW) >95th centile). METHODS Fetal growth velocity and birth outcome data were prospectively collected from 347 nulliparous women. Each had blinded ultrasound biometry performed at 28 and 36 weeks' gestation. Change in EFW and abdominal circumference (AC) centiles between 28-36 weeks were calculated, standardised over exactly eight weeks. We examined the odds of shoulder dystocia with increasing EFW and AC growth velocities among women with 36-week EFW ≤95th centile (non-LGA), who went on to have a vaginal birth. We then examined the relative risk (RR) of shoulder dystocia in cases of accelerated EFW and AC growth velocities (>30 centiles gained). Finally, we compared the predictive performances of accelerated fetal growth velocities to 36-week EFW >95th centile for shoulder dystocia among the cohort planned for vaginal birth. RESULTS Of the 226 participants who had EFW ≤95th centile at 36-week ultrasound and birthed vaginally, six (2.7%) had shoulder dystocia. For each one centile increase in EFW between 28-36 weeks, the odds of shoulder dystocia increased by 8% (odds ratio (OR [95% Confidence Interval (CI)]) = 1.08 [1.04-1.12], p<0.001). For each one centile increase in AC between 28-36 weeks, the odds of shoulder dystocia increased by 9% (OR[95%CI] = 1.09 [1.05-1.12], p<0.001). When compared to the rest of the cohort with normal growth velocity, accelerated EFW and AC velocities were associated with increased relative risks of shoulder dystocia (RR[95%CI] = 7.3 [1.9-20.6], p = 0.03 and 4.8 [1.7-9.4], p = 0.02 respectively). Accelerated EFW or AC velocities predicted shoulder dystocia with higher sensitivity and positive predictive value than 36-week EFW >95th centile. CONCLUSIONS Accelerated fetal growth velocities between 28-36 weeks' gestation are associated with increased risk of shoulder dystocia, and may predict shoulder dystocia risk better than the commonly used threshold of 36-week EFW >95th centile.
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Affiliation(s)
- Teresa M. MacDonald
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- * E-mail:
| | - Alice J. Robinson
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Richard J. Hiscock
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Hui
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten M. Dane
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Anna L. Middleton
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lucy M. Kennedy
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Stephen Tong
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan P. Walker
- Mercy Perinatal, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
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20
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Chandrasekaran N. Induction of labor for a suspected large-for-gestational-age/macrosomic fetus. Best Pract Res Clin Obstet Gynaecol 2021; 77:110-118. [PMID: 34602354 DOI: 10.1016/j.bpobgyn.2021.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
Fetal macrosomia is defined as a birth weight of >4000 g, while the term large for gestational age (LGA) is defined as an estimated fetal weight >90th centile for gestational age. Current data indicate that a significant proportion of the babies are LGA. Pregnancies involving LGA babies are associated with increased maternal and perinatal morbidity including caesarean section, postpartum hemorrhage, shoulder dystocia, and birth trauma. To reduce these complications, labor induction has been suggested as a possible solution. However, despite some high-quality evidence in favor of labor induction for suspected macrosomia/LGA, existing guidelines do not support routine induction of labor in this population. The aim of this paper is to critically appraise the available evidence and clinical practice recommendations and highlight the importance of shared decision making and individualized care based on clear counselling regarding the lack of a sensitive diagnostic tool for estimating fetal weight in the third trimester.
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21
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Self A, Papageorghiou AT. Ultrasound Diagnosis of the Small and Large Fetus. Obstet Gynecol Clin North Am 2021; 48:339-357. [PMID: 33972070 DOI: 10.1016/j.ogc.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Antenatal imaging is crucial in the management of high-risk pregnancies. Accurate dating relies on acquisition of reliable and reproducible ultrasound images and measurements. Quality image acquisition is necessary for assessing fetal growth and performing Doppler measurements to help diagnose pregnancy complications, stratify risk, and guide management. Further research is needed to ascertain whether current methods for estimating fetal weight can be improved with 3-dimensional ultrasound or magnetic resonance imaging; optimize dating with late initiation of prenatal care; minimize under-diagnosis of fetal growth restriction; and identify the best strategies to make ultrasound more available in low-income and middle-income countries.
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Affiliation(s)
- Alice Self
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Aris T Papageorghiou
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
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22
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Rizzo G, Mappa I, Bitsadze V, Khizroeva J, Makatsarya A, D'Antonio F. The added value of umbilical vein flow in predicting fetal macrosomia at 36 weeks of gestation: A prospective cohort study. Acta Obstet Gynecol Scand 2021; 100:900-907. [PMID: 33216942 DOI: 10.1111/aogs.14047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Current models based on fetal biometry and maternal characteristics have a poor performance in predicting macrosomia. The primary aim of this study was to elucidate the diagnostic performance of fetal venous and arterial Dopplers in predicting macrosomia in the third trimester of pregnancy; the secondary aim was to build a multiparametric prediction model including pregnancy, ultrasound and Doppler characteristics able to predict macrosomia accurately. MATERIAL AND METHODS Prospective cohort study including 2156 singleton pregnancies scheduled for routine ultrasound assessment at 36 weeks of gestation. Fetal biometry, estimated fetal weight (EFW), pulsatility index of the uterine, umbilical, and middle cerebral arteries, cerebroplacental ratio and umbilical vein blood flow (UVBF) normalized for fetal abdominal circumference (UVBF/AC) were recorded. Primary outcome was the prediction of fetal macrosomia, defined as a birthweight >90th percentile; secondary outcome was the prediction of newborns >4000 g. Logistic regression and area under the curve (AUC) analyses were used to analyze the data. RESULTS Fetal macrosomia complicated 9.8% of pregnancies, and 7.7% of newborns had a birthweight >4000 g. At multivariate logistic regression analysis, maternal body mass index (adjusted odds ratio [aOR] 1.23), pregestational diabetes (aOR 1.83), a prior newborn with a birthweight >95th centile (aOR 1.49), EFW (aOR 2.23) and UVBF (aOR1.84) were independently associated with macrosomia, whereas gestational diabetes mellitus (P = .07) or any of the other Doppler parameters were not. EFW had an AUC of 0.750 and of 0.801 alone and in association with maternal characteristics for the prediction of macrosomia, respectively. The addition of UVBF to this model significantly improved the prediction of fetal macrosomia provided by maternal and ultrasound parameters with an AUC of 0.892 (De Long P = .044 and P = .0078, respectively). The predictive performance for birthweight >4000 g was similar and significantly improved when UVBF was included in the diagnostic algorithm. CONCLUSIONS Umbilical vein blood flow evaluation in the third trimester improves the diagnosis of fetal macrosomia. The optimal diagnostic performance for macrosomia is achieved by a multiparametric model including umbilical vein flow, maternal characteristics and EFW.
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Affiliation(s)
- Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Ilenia Mappa
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
| | - Victoria Bitsadze
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Jamilya Khizroeva
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Alexander Makatsarya
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Francesco D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Szmyd B, Biedrzycka M, Karuga FF, Rogut M, Strzelecka I, Respondek-Liberska M. Interventricular Septal Thickness as a Diagnostic Marker of Fetal Macrosomia. J Clin Med 2021; 10:jcm10050949. [PMID: 33804406 PMCID: PMC7957748 DOI: 10.3390/jcm10050949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 12/20/2022] Open
Abstract
Serious complications in both mother and newborn arising as a result of fetal macrosomia indicate the need for early diagnosis and prevention. Unfortunately, current predictors, such as fetal biometry, fundal height, and amniotic fluid index, appear to be insufficient. Therefore, we decided to assess the predictive potential of interventricular septal thickness (IVST), as measured at ≥33 weeks of gestation. Two hundred and ninety-nine patients met the inclusion criteria: complete medical history including all necessary measurements—namely, IVST obtained by M-mode echocardiography, fetal biometry, and birth weight. The Statistica 13.1 PL software was used to generate the receiver operating curve. The optimal cut-off point (IVST of 4.7 mm) was selected using the Youden index method. The analysis of fetal biometry abnormalities resulted in 46.6% of macrosomia cases being correctly predicted; however, IVST analysis detected 71.4% of cases. IVST at ≥4.7 mm appears to have a higher sensitivity and negative predictive value (NPV) than routine ultrasound.
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Affiliation(s)
- Bartosz Szmyd
- Department of Pediatrics, Oncology, and Hematology, Medical University of Lodz, 91-738 Łódź, Poland;
| | - Małgorzata Biedrzycka
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland; (M.B.); (F.F.K.); (M.R.)
| | - Filip Franciszek Karuga
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland; (M.B.); (F.F.K.); (M.R.)
| | - Magdalena Rogut
- Student’s Scientific Association Prenatal Cardiology, Medical University of Lodz, 93-338 Łódź, Poland; (M.B.); (F.F.K.); (M.R.)
| | - Iwona Strzelecka
- Department of Diagnosis and Prevention Fetal Malformations, Medical University of Lodz, 93-338 Łódź, Poland;
- Correspondence:
| | - Maria Respondek-Liberska
- Department of Diagnosis and Prevention Fetal Malformations, Medical University of Lodz, 93-338 Łódź, Poland;
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital, 93-338 Łódź, Poland
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24
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Salameh JP, Bossuyt PM, McGrath TA, Thombs BD, Hyde CJ, Macaskill P, Deeks JJ, Leeflang M, Korevaar DA, Whiting P, Takwoingi Y, Reitsma JB, Cohen JF, Frank RA, Hunt HA, Hooft L, Rutjes AWS, Willis BH, Gatsonis C, Levis B, Moher D, McInnes MDF. Preferred reporting items for systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA): explanation, elaboration, and checklist. BMJ 2020; 370:m2632. [PMID: 32816740 DOI: 10.1136/bmj.m2632] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Jean-Paul Salameh
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Trevor A McGrath
- University of Ottawa Department of Radiology, Ottawa, ON, Canada
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital and Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Christopher J Hyde
- Exeter Test Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Jonathan J Deeks
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Mariska Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Daniël A Korevaar
- Department of Respiratory Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
| | - Penny Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Johannes B Reitsma
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Cochrane Netherlands, Utrecht, Netherlands
| | - Jérémie F Cohen
- Department of Paediatrics and Inserm UMR 1153 (Centre of Research in Epidemiology and Statistics), Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Robert A Frank
- University of Ottawa Department of Radiology, Ottawa, ON, Canada
| | - Harriet A Hunt
- Exeter Test Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lotty Hooft
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Cochrane Netherlands, Utrecht, Netherlands
| | - Anne W S Rutjes
- Institute of Social and Preventive Medicine, Berner Institut für Hausarztmedizin, University of Bern, Bern, Switzerland
| | | | | | - Brooke Levis
- Lady Davis Institute of the Jewish General Hospital and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada
| | - David Moher
- Ottawa Hospital Research Institute Clinical Epidemiology Program (Centre for Journalology), Ottawa, ON, Canada
| | - Matthew D F McInnes
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON K1E 4M9, Canada
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25
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Shub A, Lappas M. Pregestational diabetes in pregnancy: Complications, management, surveillance, and mechanisms of disease-A review. Prenat Diagn 2020; 40:1092-1098. [PMID: 32333803 DOI: 10.1002/pd.5718] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/12/2020] [Accepted: 04/20/2020] [Indexed: 12/16/2022]
Abstract
Diabetes is an increasingly common diagnosis among pregnant women. Pregestational diabetes is associated with an increase in many adverse pregnancy outcomes, which impact both on the woman and her fetus. The models of pregnancy care for women with diabetes are based largely on observational data or consensus opinion. Strategies for aneuploidy screening and monitoring for fetal well-being should be modified in women with diabetes. There is an increasing understanding of the mechanisms by which congenital anomalies and disorders of fetal growth occur, involving epigenetic modifications, changes in gene expression in critical developmental pathways, and oxidative stress. This knowledge may lead to pathways for improved care for these high-risk pregnancies.
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Affiliation(s)
- Alexis Shub
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia.,Perinatal Department, Mercy Hospital for Women, Heidelberg, Australia
| | - Martha Lappas
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Australia
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26
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Meyer R, Rottenstreich A, Tsur A, Cahan T, Shai D, Ilan H, Levin G. The effect of fetal weight on the accuracy of sonographic weight estimation among women with diabetes. J Matern Fetal Neonatal Med 2020; 35:1747-1753. [PMID: 32441174 DOI: 10.1080/14767058.2020.1769592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: The assessment of sonographic estimated fetal weight (EFW) enables identification of fetuses in the extremes of weight, thus aiding in the planning and management of peripartum care. There are conflicting reports regarding the accuracy of EFW in diabetic mothers. We aimed to study the factors associated with the accuracy of EFW at term, specifically the role of gestational and pre-gestational diabetes in this setting.Methods: A retrospective study including all women carrying singleton term gestations who delivered within a week following a sonographic fetal weight estimation between 2011 and 2019. Accurate EFW was defined as within 10% of the actual birthweight. We allocated the study cohort into two groups: (1) Accurate EFW (2) inaccurate EFW. Both groups were compared in order to identify factors associated with the inaccuracy of EFW.Results: Overall, 41,263 deliveries were available for evaluation, including 412 (1.0%) deliveries among women with pre-gestational diabetes and 4,735 (11.5%) among women with gestational diabetes. Of them, 7,280 (17.6%) had inaccurate EFW. Inaccurate EFW was associated with nulliparity, OR 0.82 [95% CI] (0.78-0.87), oligohydramnios, OR 0.81 [95% CI] (0.71-0.93), pregestational diabetes, OR [95% CI] 0.61 (0.50-0.79), and extremity of fetal weight; <2,500 grams-OR [95% CI] 0.37 (0.33-0.41) and >4,000 grams OR [95% CI] 0.52 (0.48-0.57). On multiple regression analysis, the following factors were independently associated with inaccurate EFW: pregestational diabetes, OR [95% CI] 0.58 (0.46-0.73), p < .001, nulliparity, OR [95% CI] 0.86 (0.82-0.91), p < .001 and higher fetal weight (for each 500 grams), OR [95% CI [1.25 (1.21-1.30), p < .001. On analysis of different weight categories, pregestational diabetes was associated with inaccurate EFW only in those with birthweight >3,500 grams, OR [95% CI] 0.37 (0.24-0.56) (p < .001).Conclusion: Among pregestational diabetic women, the accuracy of sonographic EFW when assessed to be >3,500 grams is questionable. This should be taken into consideration when consulting women and planning delivery management.Synopsis: Among pregestational diabetic women, the accuracy of estimated sonographic fetal weight higher than 3,500 grams is of limited accuracy.
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Affiliation(s)
- Raanan Meyer
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abraham Tsur
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Tal Cahan
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Daniel Shai
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Hadas Ilan
- Department of Obstetrics and Gynecology, the Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Kopylov AT, Kaysheva AL, Papysheva O, Gribova I, Kotaysch G, Kharitonova L, Mayatskaya T, Krasheninnikova A, Morozov SG. Association of Proteins Modulating Immune Response and Insulin Clearance During Gestation with Antenatal Complications in Patients with Gestational or Type 2 Diabetes Mellitus. Cells 2020; 9:cells9041032. [PMID: 32326243 PMCID: PMC7226479 DOI: 10.3390/cells9041032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The purpose of the study is to establish and quantitatively assess protein markers and their combination in association with insulin uptake that may be have value for early prospective recognition of diabetic fetopathy (DF) as a complication in patients with diabetes mellitus during gestation. Methods: Proteomic surveying and accurate quantitative measurement of selected proteins from plasma samples collected from the patients with gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) who gave birth of either healthy or affected by maternal diabetes newborns was performed using mass spectrometry. Results: We determined and quantitatively measured several proteins, including CRP, CEACAM1, CNDP1 and Ig-family that were significantly differed in patients that gave birth of newborns with signs of DF. We found that patients with newborns associated with DF are characterized by significantly decreased CEACAM1 (113.18 ± 16.23 ng/mL and 81.09 ± 10.54 ng/mL in GDM and T2DM, p < 0.005) in contrast to control group (515.6 ± 72.14 ng/mL, p < 0.005). On the contrary, the concentration of CNDP1 was increased in DF-associated groups and attained 49.3 ± 5.18 ng/mL and 37.7 ± 3.34 ng/mL (p < 0.005) in GDM and T2DM groups, respectively. Among other proteins, dramatically decreased concentration of IgG4 and IgA2 subclasses of immunoglobulins were noticed. Conclusion: The combination of the measured markers may assist (AUC = 0.893 (CI 95%, 0.785–0.980) in establishing the clinical finding of the developing DF especially in patients with GDM who are at the highest risk of chronic insulin resistance.
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Affiliation(s)
- Arthur T. Kopylov
- Institute of General Pathology and Pathophysiology, Department of Pathology, 125315 Moscow, Russia; (A.K.); (S.G.M.)
- Institute of Biomedical Chemistry, Department of Proteomic Researches, 119121 Moscow, Russia;
- Correspondence: ; Tel.: +7-926-185-4049
| | - Anna L. Kaysheva
- Institute of Biomedical Chemistry, Department of Proteomic Researches, 119121 Moscow, Russia;
| | - Olga Papysheva
- Sergey S. Yudin 7th State Clinical Hospital, Perinatal Center, 115446 Moscow, Russia;
| | - Iveta Gribova
- Nikolay E. Bauman 29th State Clinical Hospital, 110020 Moscow, Russia; (I.G.); (G.K.)
- “Biopharm-Test” Limited Liability Company, 121170 Moscow, Russia
| | - Galina Kotaysch
- Nikolay E. Bauman 29th State Clinical Hospital, 110020 Moscow, Russia; (I.G.); (G.K.)
| | - Lubov Kharitonova
- Nikolay I. Pirogov Medical University, 117997 Moscow, Russia; (L.K.); (T.M.)
| | - Tatiana Mayatskaya
- Nikolay I. Pirogov Medical University, 117997 Moscow, Russia; (L.K.); (T.M.)
| | - Anna Krasheninnikova
- Institute of General Pathology and Pathophysiology, Department of Pathology, 125315 Moscow, Russia; (A.K.); (S.G.M.)
| | - Sergey G. Morozov
- Institute of General Pathology and Pathophysiology, Department of Pathology, 125315 Moscow, Russia; (A.K.); (S.G.M.)
- Nikolay E. Bauman 29th State Clinical Hospital, 110020 Moscow, Russia; (I.G.); (G.K.)
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Bicocca MJ, Le TN, Zhang CC, Blackburn B, Blackwell SC, Sibai BM, Chauhan SP. Identification of newborns with birthweight ≥ 4,500g: Ultrasound within one- vs. two weeks of delivery. Eur J Obstet Gynecol Reprod Biol 2020; 249:47-53. [PMID: 32353616 DOI: 10.1016/j.ejogrb.2020.04.028] [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: 01/25/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Our objective was to compare the diagnostic characteristics of sonographic estimated fetal weight (SEFW) done within 7 versus 8-14 days before delivery for detection of fetal macrosomia (birthweight ≥ 4500 g). STUDY DESIGN We performed a multicenter, retrospective cohort study of all non-anomalous singletons with SEFW ≥ 4000 g by Registered Diagnostic Medical Sonographers conducted within 14 days of delivery. Cohorts were grouped by time interval between ultrasound and delivery: 0-7 days versus 8-14 days. The detection rate (DR) and false positive rate (FPR) for detection of birthweight (BW) ≥ 4500 g were compared between groups with subgroup analysis for diabetic women. Area under the receiver operator curve (AUC) was calculated to analyze all possible SEFW cutoffs within our cohort. RESULTS A total of 330 patients met inclusion criteria with 250 (75.8 %) having SEFW within 7 days and 80 (24.2 %) with SEFW 8-14 days prior to delivery. The rate of macrosomia was 15.1 % (N = 51). The DR for macrosomia was significantly higher when SEFW was performed within 7 days of delivery compared to 8-14 days among non-diabetic (73.0 % vs 7.1 %; p < 0.001) and diabetic women (76.5 % vs 16.7 %; p = 0.02). There was no significant change in FPR in either group. The AUC for detection of macrosomia was significantly higher when SEFW was performed within 7 days versus 8-14 days (0.89 vs 0.63; p < 0.01). CONCLUSION With SEFW ≥ 4000 g, the detection of BW ≥ 4500 g is significantly higher when the sonographic examination is within 7 days of birth irrespective of maternal diabetes.
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Affiliation(s)
- Matthew J Bicocca
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States.
| | - Tran N Le
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Caroline C Zhang
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Bonnie Blackburn
- Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, TX, United States
| | - Sean C Blackwell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Baha M Sibai
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Suneet P Chauhan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Robinson R, Walker KF, White VA, Bugg GJ, Snell KIE, Jones NW. The test accuracy of antenatal ultrasound definitions of fetal macrosomia to predict birth injury: A systematic review. Eur J Obstet Gynecol Reprod Biol 2020; 246:79-85. [PMID: 31978846 DOI: 10.1016/j.ejogrb.2020.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine which ultrasound measurement for predicted fetal macrosomia most accurately predicts adverse delivery and neonatal outcomes. STUDY DESIGN Four biomedical databases searched for studies published after 1966. Randomised trials or observational studies of women with singleton pregnancies, resulting in a term birth who have undergone an index test of interest measured and recorded as predicted fetal macrosomia ≥28 weeks. Adverse outcomes of interest included shoulder dystocia, brachial plexus injury (BPI) and Caesarean section. RESULTS Twenty-five observational studies (13,285 participants) were included. For BPI, the only significant positive association was found for Abdominal Circumference (AC) to Head Circumference (HC) difference > 50 mm (OR 7.2, 95 % CI 1.8-29). Shoulder dystocia was significantly associated with abdominal diameter (AD) minus biparietal diameter (BPD) ≥ 2.6 cm (OR 4.2, 95 % CI 2.3-7.5, PPV 11 %) and AC > 90th centile (OR 2.3, 95 % CI 1.3-4.0, PPV 8.6 %) and an estimated fetal weight (EFW) > 4000 g (OR 2.1 95 %CI 1.0-4.1, PPV 7.2 %). CONCLUSIONS Estimated fetal weight is the most widely used ultrasound marker to predict fetal macrosomia in the UK. This study suggests other markers have a higher positive predictive value for adverse outcomes associated with fetal macrosomia.
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Affiliation(s)
- Rebecca Robinson
- Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby, DE22 3NE, United Kingdom
| | - Kate F Walker
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, United Kingdom.
| | - Victoria A White
- Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom
| | - George J Bugg
- Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, United Kingdom
| | - Kym I E Snell
- Centre for Prognosis Research, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, ST5 5BG, United Kingdom
| | - Nia W Jones
- Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, United Kingdom
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Liao K, Tang L, Peng C, Chen L, Chen R, Huang L, Liu P, Chen C. Two new models for the estimation of foetal weight more than a week before delivery: An MRI study. Eur J Radiol 2019; 121:108596. [PMID: 31623899 DOI: 10.1016/j.ejrad.2019.06.026] [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: 04/03/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To develop and evaluate new formulas to determine the magnetic resonance imaging (MRI)-based estimated foetal weight (EFW) more than a week before delivery. METHODS The study included 153 women with singleton pregnancies who gave birth to live, normal neonates within 15-21 days of the MRI examination for whom foetal body volume biometry data were available at term. All foetuses were randomly divided into a testing group (102) and a validation group (51). Regression analysis was used to determine the single volume or the combination of volume and MRI-to-delivery interval that determined the EFW. The accuracy of the two new models and the primary existing model developed by Baker et al. were evaluated in validation group. RESULTS The two new models had similar mean percentage errors (MPEs) (3.9% vs 3.9%) and proportions of pregnancies with an MPE < 10% (92.2% vs 90.2%); the model incorporating volume and MRI-to-delivery had relatively higher proportions of pregnancies with an MPE < 5% (72.5% vs 64.7%) and EFWs in agreement with the birth weights. The error in the Baker model was almost twice that in the new models. CONCLUSION The accuracy of foetal weight estimation more than one week before delivery using the model developed by Baker et al. was poor and was significantly improved by the new models. A combination of the foetal body volume and MRI-to-delivery interval will enable the more accurate determination of the EFWs.
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Affiliation(s)
- Kedan Liao
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Lian Tang
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Cheng Peng
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Lan Chen
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiying Chen
- Department of Radiology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Lu Huang
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China.
| | - Chunlin Chen
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China.
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Salomon LJ, Alfirevic Z, Da Silva Costa F, Deter RL, Figueras F, Ghi T, Glanc P, Khalil A, Lee W, Napolitano R, Papageorghiou A, Sotiriadis A, Stirnemann J, Toi A, Yeo G. ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 53:715-723. [PMID: 31169958 DOI: 10.1002/uog.20272] [Citation(s) in RCA: 269] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 05/09/2023]
Abstract
INTRODUCTION These Guidelines aim to describe appropriate assessment of fetal biometry and diagnosis of fetal growth disorders. These disorders consist mainly of fetal growth restriction (FGR), also referred to as intrauterine growth restriction (IUGR) and often associated with small‐for‐gestational age (SGA), and large‐for‐gestational age (LGA), which may lead to fetal macrosomia; both have been associated with a variety of adverse maternal and perinatal outcomes. Screening for, and adequate management of, fetal growth abnormalities are essential components of antenatal care, and fetal ultrasound plays a key role in assessment of these conditions. The fetal biometric parameters measured most commonly are biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur diaphysis length (FL). These biometric measurements can be used to estimate fetal weight (EFW) using various different formulae1. It is important to differentiate between the concept of fetal size at a given timepoint and fetal growth, the latter being a dynamic process, the assessment of which requires at least two ultrasound scans separated in time. Maternal history and symptoms, amniotic fluid assessment and Doppler velocimetry can provide additional information that may be used to identify fetuses at risk of adverse pregnancy outcome. Accurate estimation of gestational age is a prerequisite for determining whether fetal size is appropriate‐for‐gestational age (AGA). Except for pregnancies arising from assisted reproductive technology, the date of conception cannot be determined precisely. Clinically, most pregnancies are dated by the last menstrual period, though this may sometimes be uncertain or unreliable. Therefore, dating pregnancies by early ultrasound examination at 8–14 weeks, based on measurement of the fetal crown–rump length (CRL), appears to be the most reliable method to establish gestational age. Once the CRL exceeds 84 mm, HC should be used for pregnancy dating2–4. HC, with or without FL, can be used for estimation of gestational age from the mid‐trimester if a first‐trimester scan is not available and the menstrual history is unreliable. When the expected delivery date has been established by an accurate early scan, subsequent scans should not be used to recalculate the gestational age1. Serial scans can be used to determine if interval growth has been normal. In these Guidelines, we assume that the gestational age is known and has been determined as described above, the pregnancy is singleton and the fetal anatomy is normal. Details of the grades of recommendation used in these Guidelines are given in Appendix 1. Reporting of levels of evidence is not applicable to these Guidelines.
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Affiliation(s)
- L J Salomon
- Department of Obstetrics and Fetal Medicine, Hopital Necker-Enfants Malades, Assistance Publique-Hopitaux de Paris, Paris Descartes University, Paris, France
| | - Z Alfirevic
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - F Da Silva Costa
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
| | - R L Deter
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - F Figueras
- Hospital Clinic, Obstetrics and Gynecology, Barcelona, Spain
| | - T Ghi
- Obstetrics and Gynecology Unit, University of Parma, Parma, Italy
| | - P Glanc
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - W Lee
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, TX, USA
| | - R Napolitano
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Obstetrics and Gynecology, University of Oxford, Women's Center, John Radcliffe Hospital, Oxford, UK
| | - A Sotiriadis
- Second Department of Obstetrics and Gynecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - J Stirnemann
- Obstetrics, University Paris Descartes, Hôpital Necker Enfants Malades, Paris, France
| | - A Toi
- Medical Imaging, Mount Sinai Hospital, Toronto, ON, Canada
| | - G Yeo
- Department of Maternal Fetal Medicine, Obstetric Ultrasound and Prenatal Diagnostic Unit, KK Women's and Children's Hospital, Singapore
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Preyer O, Husslein H, Concin N, Ridder A, Musielak M, Pfeifer C, Oberaigner W, Husslein P. Fetal weight estimation at term - ultrasound versus clinical examination with Leopold's manoeuvres: a prospective blinded observational study. BMC Pregnancy Childbirth 2019; 19:122. [PMID: 30971199 PMCID: PMC6458793 DOI: 10.1186/s12884-019-2251-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fetal weight estimation is of key importance in the decision-making process for obstetric planning and management. The literature is inconsistent on the accuracy of measurements with either ultrasound or clinical examination, known as Leopold's manoeuvres, shortly before term. Maternal BMI is a confounding factor because it is associated with both the fetal weight and the accuracy of fetal weight estimation. The aim of our study was to compare the accuracy of fetal weight estimation performed with ultrasound and with clinical examination with respect to BMI. METHODS In this prospective blinded observational study we investigated the accuracy of clinical examination as compared to ultrasound measurement in fetal weight estimation, taking the actual birth weight as the gold standard. In a cohort of all consecutive patients who presented in our department from January 2016 to May 2017 to register for delivery at ≥37 weeks, examination was done by ultrasound and Leopold's manoeuvres to estimate fetal weight. All examiners (midwives and physicians) had about the same level of professional experience. The primary aim was to compare overall absolute error, overall absolute percent error, absolute percent error > 10% and absolute percent error > 20% for weight estimation by ultrasound and by means of Leopold's manoeuvres versus the actual birth weight as the given gold standard, namely separately for normal weight and for overweight pregnant women. RESULTS Five hundred forty-three patients were included in the data analysis. The accuracy of fetal weight estimation was significantly better with ultrasound than with Leopold's manoeuvres in all absolute error calculations made in overweight pregnant women. For all error calculations performed in normal weight pregnant women, no statistically significant difference was seen in the accuracy of fetal weight estimation between ultrasound and Leopold's manoeuvres. CONCLUSIONS Data from our prospective blinded observational study show a significantly better accuracy of ultrasound for fetal weight estimation in overweight pregnant women only as compared to Leopold's manoeuvres with a significant difference in absolute error. We did not observe significantly better accuracy of ultrasound as compared to Leopold's manoeuvres in normal weight women. Further research is needed to analyse the situation in normal weight women.
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Affiliation(s)
- Oliver Preyer
- Department of Obstetrics and Gynaecology, University Teaching Hospital Tauernklinikum Zell am See, Paracelsusstrasse 8, A-5700, Zell am See, Austria.
| | - Heinrich Husslein
- Department of Obstetrics and Gynaecology, Division of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Nicole Concin
- Department of Obstetrics and Gynaecology, Medical University of Innsbruck, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Anna Ridder
- Paracelsus Medical University, Strubergasse 21, A-5020, Salzburg, Austria
| | - Maciej Musielak
- Department of Obstetrics and Gynaecology, University Teaching Hospital Tauernklinikum Zell am See, Paracelsusstrasse 8, A-5700, Zell am See, Austria
| | - Christian Pfeifer
- Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Cancer Registry of Tyrol, Tirolkliniken GmbH, Anichstrasse 35, A-6020, Innsbruck, Austria
| | - Willi Oberaigner
- Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Cancer Registry of Tyrol, Tirolkliniken GmbH, Anichstrasse 35, A-6020, Innsbruck, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and HTA, UMIT The Health & Life Sciences University, Eduard-Wallnöfer-Zentrum 1, A-6060, Hall in Tirol, Austria
| | - Peter Husslein
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
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Kadji C, Cannie MM, Carlin A, Jani JC. Protocol for the prospective observational clinical study: estimation of fetal weight by MRI to PREdict neonatal MACROsomia (PREMACRO study) and small-for-gestational age neonates. BMJ Open 2019; 9:e027160. [PMID: 30918039 PMCID: PMC6475185 DOI: 10.1136/bmjopen-2018-027160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Macrosomia refers to growth beyond a specific threshold, regardless of gestational age. These fetuses are also frequently referred to as large for gestational age (LGA). Various cut-offs have been used but for research purposes, a cut-off above the 95th centile for birth weight is often preferred because it defines 90% of the population as normal weight. The use of centiles, rather than estimated weights, also accommodates preterm macrosomic infants, although most of the complications, maternal and fetal, arise during the delivery of large babies at term. This means that accurate identification of LGA fetuses (≥95th centile) may play an important role in guiding obstetric interventions, such as induction of labour or caesarean section. Traditionally, identification of fetuses suspected of macrosomia has been based on biometric measurements using two-dimensional (2D) ultrasound (US), yet this method is rather sub-optimal. We present a protocol (V.2.1, date 19 May 2016) for the estimation of fetal weight (EFW) by MRI to PREdict neonatal MACROsomia (PREMACRO study), which is a prospective observational clinical study designed to determine whether MRI at 36 + 0 to 36 + 6 weeks of gestation, as compared with 2D US, can improve the identification of LGA neonates ≥95th centile. METHODS AND ANALYSIS All eligible women attending the 36-week clinic will be invited to participate in the screening study for LGA fetuses ≥95th centile and will undergo US-EFW and MRI-EFW within minutes of each other. From these estimations, a centile will be derived which will be compared with the centile of birth weight used as the gold standard. Besides birth weight, other pregnancy and neonatal outcomes will be collected and analysed. The first enrolment for the study was in May 2016. As of September 2018, 2004 women have been screened and recruited to the study. The study is due to end in April 2019. ETHICS AND DISSEMINATION The study will be conducted in accordance with the International Conference on Harmonisation for good clinical practice and the appropriate regulatory requirement(s). A favourable ethical opinion was obtained from the Ethics Committee of the University Hospital Brugmann, reference number CE2016/44. Results will be published in peer-reviewed journals and disseminated at international conferences. TRIAL REGISTRATION NUMBER NCT02713568.
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Affiliation(s)
- Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Liao K, Tang L, Peng C, Chen L, Chen R, Huang L, Liu P, Chen C. A modified model can improve the accuracy of foetal weight estimation by magnetic resonance imaging. Eur J Radiol 2018; 110:242-248. [PMID: 30599867 DOI: 10.1016/j.ejrad.2018.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine whether birth weight can be reliably estimated using three-dimensional (3D) magnetic resonance imaging (MRI) foetal body volume at term. METHOD Foetuses between 37+5 weeks and 41 weeks of gestation were delivered within 7 days after MRI and ultrasound (US) examinations. 3D foetal models were reconstructed from MRI data, and body volume was calculated. The MRI-based weight estimations were calculated using the Baker equation and the modified Baker equation with a higher density coefficient. The US-based weight estimations were determined using the formula by Hadlock. Estimations based on MRI and US were compared with the birth weights. RESULTS Among 22 foetuses that underwent both US and MRI evaluations within 48 h before labour, the mean random errors for the estimated weight based on US, the Baker equation and the modified Baker equation were 6.5%, 4.8%, and 4.8%, respectively, and these methods correctly estimated the weights of 77.3%, 86.4% and 100% of the foetuses to within 10% of the actual birth weight. The weights of 95.5% of the foetuses were underestimated by the Baker equation. Similar findings were observed among 103 estimations based on both US and MRI within 7 days before delivery. The mean relative error of the MRI-determined estimate of foetal weight using the modified Baker equation was not significantly associated with foetal sex, birth weight, gestational age at MRI examination, the MRI-to-delivery interval or the type of MRI scanner. CONCLUSION A modified Baker equation with a high-density coefficient can improve the accuracy of foetal weight estimation based on 3D MRI foetal volume at term, and its accuracy was not significantly affected by foetal characteristics or the type of MRI scanner among births occurring within 7 days after examinations.
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Affiliation(s)
- Kedan Liao
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Lian Tang
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Cheng Peng
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Lan Chen
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Ruiying Chen
- Department of Radiology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Lu Huang
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Liu
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China.
| | - Chunlin Chen
- Department of Obstetrics and Gynaecology, NanFang Hospital, Southern Medical University, Guangzhou, China.
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Kadji C, Cannie MM, De Angelis R, Camus M, Klass M, Fellas S, Cecotti V, Dütemeyer V, Jani JC. Prenatal prediction of postnatal large-for-dates neonates using a simplified MRI method: comparison with conventional 2D ultrasound estimates. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:250-257. [PMID: 28508549 DOI: 10.1002/uog.17523] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/30/2017] [Accepted: 05/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate the performance of a simple semi-automated method for estimation of fetal weight (EFW) using magnetic resonance imaging (MRI) as compared with two-dimensional (2D) ultrasound (US) for the prediction of large-for-dates neonates. METHODS Data of two groups of women with singleton pregnancy between March 2011 and May 2016 were retrieved from our database and evaluated retrospectively: the first group included women who underwent US-EFW and MRI-EFW within 48 h before delivery and the second group included women who had these evaluations between 35 + 0 weeks and 37 + 6 weeks of gestation, more than 48 h before delivery. US-EFW was based on Hadlock et al. and MRI-EFW on the formula described by Baker et al. For MRI-EFW, planimetric measurement of the fetal body volume (FBV) was performed using a semi-automated method and the time required for measurement was noted. Outcome measure was the performance of MRI-EFW vs US-EFW in the prediction of large-for-dates neonates, both ≤ 48 h and > 48 h before delivery. Receiver-operating characteristics (ROC) curves for each method were compared using the DeLong method. RESULTS Of the 270 women included in the first group, 48 (17.8%) newborns had birth weight ≥ 90th centile and 30 (11.1%) ≥ 95th centile. The second group included 83 women, and nine (10.8%) newborns had birth weight ≥ 95th centile. Median time needed for FBV planimetric measurements in all 353 fetuses was 3.5 (range, 1.5-5.5) min. The area under the ROC curve (AUC) for prediction of large-for-dates neonates by prenatal MRI performed within 48 h before delivery was significantly higher than that by US (for birth weight ≥ 90th centile, difference between AUCs = 0.085, standard error (SE) = 0.020, P < 0.001; for birth weight ≥ 95th centile, difference between AUCs = 0.036, SE = 0.014, P = 0.01). Similarly, MRI-EFW was better than US-EFW in predicting birth weight ≥ 95th centile when both examinations were performed > 48 h prior to delivery (difference between AUCs = 0.077, SE = 0.039, P = 0.045). CONCLUSION MRI planimetry using our purpose-designed semi-automated method is not time-consuming. The predictive performance of MRI-EFW performed immediately prior to or remote from delivery is significantly better than that of US-EFW for the prediction of large-for-dates neonates. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - M M Cannie
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - R De Angelis
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium
| | - M Camus
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - M Klass
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - S Fellas
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - V Cecotti
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - V Dütemeyer
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
| | - J C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Brussels, Belgium
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Macrosomia. A Systematic Review of Recent Literature. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Background and aims: The obesity and overweight rate among women of childbearing age and fetal macrosomia associated with different birth injuries are very frequent all over the world and with an increasing incidence. The huge amount of published literature on this topic in the last decade is putting the practioners in a very challenging position. Material and method: We have done a systematic review on the recent literature (last five years) based on science direct database. Results: A total of 5990 articles were identified and after successive exclusion of some of them, 48 were deeply analyzed. The results were grouped in following topics: risk factors for fetal macrosomia, the pathophysiology of macrosomia, prenatal clinical and lab diagnosis and prevention of macrosomia. Conclusions: Considering the maternal, fetal and neonatal complications of macrosomia, the counseling, and monitoring of the pregnant women risk group are of particular importance for adopting a low calorie / low glycemic diet and avoiding a sedentary behaviour. Long-term follow-up of the mother and the macrosomic baby is required because of the risk of obesity, diabetes, hypertension, and metabolic syndrome later in life.
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Fetal biometry to assess the size and growth of the fetus. Best Pract Res Clin Obstet Gynaecol 2018; 49:3-15. [DOI: 10.1016/j.bpobgyn.2018.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 02/14/2018] [Indexed: 01/13/2023]
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Schaefer-Graf U, Napoli A, Nolan CJ. Diabetes in pregnancy: a new decade of challenges ahead. Diabetologia 2018; 61:1012-1021. [PMID: 29356835 PMCID: PMC6448995 DOI: 10.1007/s00125-018-4545-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/21/2017] [Indexed: 01/13/2023]
Abstract
Every 10 years, the Diabetic Pregnancy Study Group, a study group of the EASD, conducts an audit meeting to review the achievements of the preceding decade and to set the directions for research and clinical practice improvements for the next decade. The most recent meeting focused on the following areas: improving pregnancy outcomes for women with pregestational type 1 diabetes and type 2 diabetes; the influence of obesity and gestational diabetes on pregnancy outcomes; the determinants and assessment of fetal growth and development; and public health issues, including consideration of transgenerational consequences and economic burden. The audit meeting also considered the likely impact of 'omics' on research within the field and the potential of these technologies to enable precision-medicine approaches to management. Through sharing of the findings and ideas of audit meeting participants, the DPSG hopes to promote networking, research and advances in clinical care, to improve outcomes for all women and their offspring affected by diabetes and obesity in pregnancy.
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Affiliation(s)
- Ute Schaefer-Graf
- Berlin Center for Diabetes in Pregnancy, Department of Obstetrics and Gynecology, St Joseph's Hospital, Wüsthoffstraße 15, 12101, Berlin, Germany.
- Department of Obstetrics, Charité, Humboldt University, Berlin, Germany.
| | - Angela Napoli
- Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Christopher J Nolan
- Department of Endocrinology, The Canberra Hospital, Garran, ACT, Australia
- Australian National University Medical School and John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
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Matthew J, Malamateniou C, Knight CL, Baruteau KP, Fletcher T, Davidson A, McCabe L, Pasupathy D, Rutherford M. A comparison of ultrasound with magnetic resonance imaging in the assessment of fetal biometry and weight in the second trimester of pregnancy: An observer agreement and variability study. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2018; 26:229-244. [PMID: 30479638 DOI: 10.1177/1742271x17753738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
Abstract
Objective To compare the intra and interobserver variability of ultrasound and magnetic resonance imaging in the assessment of common fetal biometry and estimated fetal weight in the second trimester. Methods Retrospective measurements on preselected image planes were performed independently by two pairs of observers for contemporaneous ultrasound and magnetic resonance imaging studies of the same fetus. Four common fetal measurements (biparietal diameter, head circumference, abdominal circumference and femur length) and an estimated fetal weight were analysed for 44 'low risk' cases. Comparisons included, intra-class correlation coefficients, systematic error in the mean differences and the random error. Results The ultrasound inter- and intraobserver agreements for ultrasound were good, except intraobserver abdominal circumference (intra-class correlation coefficient = 0.880, poor), significant increases in error was seen with larger abdominal circumference sizes. Magnetic resonance imaging produced good/excellent intraobserver agreement with higher intra-class correlation coefficients than ultrasound. Good interobserver agreement was found for both modalities except for the biparietal diameter (magnetic resonance imaging intra-class correlation coefficient = 0.942, moderate). Systematic errors between modalities were seen for the biparietal diameter, femur length and estimated fetal weight (mean percentage error = +2.5%, -5.4% and -8.7%, respectively, p < 0.05). Random error was above 5% for ultrasound intraobserver abdominal circumference, femur length and estimated fetal weight and magnetic resonance imaging interobserver biparietal diameter, abdominal circumference, femur length and estimated fetal weight (magnetic resonance imaging estimated fetal weight error >10%). Conclusion Ultrasound remains the modality of choice when estimating fetal weight, however with increasing application of fetal magnetic resonance imaging a method of assessing fetal weight is desirable. Both methods are subject to random error and operator dependence. Assessment of calliper placement variations may be an objective method detecting larger than expected errors in fetal measurements.
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Affiliation(s)
- Jacqueline Matthew
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Hospital Foundation Trust, London, UK
| | - Christina Malamateniou
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Department of Family Care and Mental Health, Faculty of Education and Health, University of Greenwich, London, UK
| | - Caroline L Knight
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Department of Women and Children's Health, King's College London, King's Health Partners, St. Thomas' Hospital, London, UK
| | - Kelly P Baruteau
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tara Fletcher
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK.,Radiology Department, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Alice Davidson
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Laura McCabe
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
| | - Dharmintra Pasupathy
- Department of Family Care and Mental Health, Faculty of Education and Health, University of Greenwich, London, UK
| | - Mary Rutherford
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, King's Health Partners, St Thomas' Hospital, London, UK
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Carlin A, Kadji C, De Angelis R, Cannie MM, Jani JC. Prenatal prediction of small-for-gestational age neonates using MR imaging: comparison with conventional 2D ultrasound. J Matern Fetal Neonatal Med 2017; 32:1673-1681. [DOI: 10.1080/14767058.2017.1414797] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Andrew Carlin
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium
| | | | - Mieke M. Cannie
- Department of Radiology, University Hospital Brugmann, Brussels, Belgium
- Department of Radiology, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jacques C. Jani
- Department of Obstetrics and Gynaecology, University Hospital Brugmann, Brussels, Belgium
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Sonographic Examination of The Fetus Vis-à-Vis Shoulder Dystocia: A Vexing Promise. Clin Obstet Gynecol 2017; 59:795-802. [PMID: 27681691 DOI: 10.1097/grf.0000000000000241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since antepartum and intrapartum risk factors are poor at identifying women whose labor is complicated by shoulder dystocia, sonographic examination of the fetus holds promise. Though there are several measurements of biometric parameters to identify the parturient who will have shoulder dystocia, none are currently clinically useful. Three national guidelines confirm that sonographic measurements do not serve as appropriate diagnostic tests to identify women who will have shoulder dystocia with or without concurrent injury. In summary, biometric measurements of the fetus should not be used to alter clinical management with the aim of averting shoulder dystocia.
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Araujo Júnior E, Peixoto AB, Zamarian ACP, Elito Júnior J, Tonni G. Macrosomia. Best Pract Res Clin Obstet Gynaecol 2017; 38:83-96. [DOI: 10.1016/j.bpobgyn.2016.08.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 01/05/2023]
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Carlson NS. Current Resources for Evidence-Based Practice, September/October 2016. J Obstet Gynecol Neonatal Nurs 2016; 45:e57-66. [DOI: 10.1016/j.jogn.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Maruotti GM, Saccone G, Martinelli P. Third trimester ultrasound soft-tissue measurements accurately predicts macrosomia. J Matern Fetal Neonatal Med 2016; 30:972-976. [DOI: 10.1080/14767058.2016.1193144] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Boulvain M, Irion O, Dowswell T, Thornton JG. Induction of labour at or near term for suspected fetal macrosomia. Cochrane Database Syst Rev 2016; 2016:CD000938. [PMID: 27208913 PMCID: PMC7032677 DOI: 10.1002/14651858.cd000938.pub2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
EDITORIAL NOTE It has been brought to the authors' attention that there may be an error in the data (Analysis 1.9). This is currently under investigation, and a correction will be made if the data are found to be incorrect. Details can be found in the comments. BACKGROUND Women with a suspected large-for-dates fetus or a fetus with suspected macrosomia (birthweight greater than 4000 g) are at risk of operative birth or caesarean section. The baby is also at increased risk of shoulder dystocia and trauma, in particular fractures and brachial plexus injury. Induction of labour may reduce these risks by decreasing the birthweight, but may also lead to longer labours and an increased risk of caesarean section. OBJECTIVES To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on the way of giving birth and maternal or perinatal morbidity. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2016), contacted trial authors and searched reference lists of retrieved studies. SELECTION CRITERIA Randomised trials of induction of labour for suspected fetal macrosomia. DATA COLLECTION AND ANALYSIS Review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We contacted study authors for additional information. For key outcomes the quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included four trials, involving 1190 women. It was not possible to blind women and staff to the intervention, but for other 'Risk of bias' domains these studies were assessed as being at low or unclear risk of bias.Compared to expectant management, there was no clear effect of induction of labour for suspected macrosomia on the risk of caesarean section (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.76 to 1.09; 1190 women; four trials, moderate-quality evidence) or instrumental delivery (RR 0.86, 95% CI 0.65 to 1.13; 1190 women; four trials, low-quality evidence). Shoulder dystocia (RR 0.60, 95% CI 0.37 to 0.98; 1190 women; four trials, moderate-quality evidence), and fracture (any) (RR 0.20, 95% CI 0.05 to 0.79; 1190 women; four studies, high-quality evidence) were reduced in the induction of labour group. There were no clear differences between groups for brachial plexus injury (two events were reported in the control group in one trial, low-quality evidence). There was no strong evidence of any difference between groups for measures of neonatal asphyxia; low five-minute infant Apgar scores (less than seven) or low arterial cord blood pH (RR 1.51, 95% CI 0.25 to 9.02; 858 infants; two trials, low-quality evidence; and, RR 1.01, 95% CI 0.46 to 2.22; 818 infants; one trial, moderate-quality evidence, respectively). Mean birthweight was lower in the induction group, but there was considerable heterogeneity between studies for this outcome (mean difference (MD) -178.03 g, 95% CI -315.26 to -40.81; 1190 infants; four studies; I(2) = 89%). In one study with data for 818 women, third- and fourth-degree perineal tears were increased in the induction group (RR 3.70, 95% CI 1.04 to 13.17).For outcomes assessed using GRADE, we based our downgrading decisions on high risk of bias from lack of blinding and imprecision of effect estimates. AUTHORS' CONCLUSIONS Induction of labour for suspected fetal macrosomia has not been shown to alter the risk of brachial plexus injury, but the power of the included studies to show a difference for such a rare event is limited. Also antenatal estimates of fetal weight are often inaccurate so many women may be worried unnecessarily, and many inductions may not be needed. Nevertheless, induction of labour for suspected fetal macrosomia results in a lower mean birthweight, and fewer birth fractures and shoulder dystocia. The unexpected observation in the induction group of increased perineal damage, and the plausible, but of uncertain significance, observation of increased use of phototherapy, both in the largest trial, should also be kept in mind.Findings from trials included in the review suggest that to prevent one fracture it would be necessary to induce labour in 60 women. Since induction of labour does not appear to alter the rate of caesarean delivery or instrumental delivery, it is likely to be popular with many women. In settings where obstetricians can be reasonably confident about their scan assessment of fetal weight, the advantages and disadvantages of induction at or near term for fetuses suspected of being macrosomic should be discussed with parents.Although some parents and doctors may feel the evidence already justifies induction, others may justifiably disagree. Further trials of induction shortly before term for suspected fetal macrosomia are needed. Such trials should concentrate on refining the optimum gestation of induction, and improving the accuracy of the diagnosis of macrosomia.
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Affiliation(s)
- Michel Boulvain
- Département de Gynécologie et d'Obstétrique, Unité de Développement en Obstétrique, Maternité Hôpitaux Universitaires de Genève, Boulevard de la Cluse, 32, Genève 14, Switzerland, CH-1211
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