exudates and Fetal-Macrosomia

To identify the risk factors influencing the development of macrosomia among pregnant women and to develop a regression model to predict macrosomia.. A cross-sectional study was conducted in a tertiary hospital in Malaysia involving 2332 pregnant women. The data was retrospectively collected from the obstetrics and gynecology department. The factors that influence fetal weight were collected from the antenatal cards and any additional information was collected by face-to-face interview using a questionnaire. A multiple regression model was developed to predict macrosomia using SPSS ver.18.. The significant variables that influence macrosomia in this study were mother's age, mother's body mass index (BMI), weight gain, parity, mother's ethnicity, father's BMI, gestational week, diabetes during pregnancy and neonatal sex. Diabetes during pregnancy is an important risk factor for macrosomia; by using this parameter alone the risk of macrosomia can be predicted with a sensitivity rate of 70% and specificity of 70%. By including other maternal factors such as maternal age, pre-pregnancy BMI, weight gain, parity, ethnicity, as well as father's BMI, gestational weeks and neonate sex, the sensitivity and specificity were improved to 80% and 75%, respectively.. A regression model was developed and this could be used in health centers to predict macrosomia for purpose of referral to higher centers.

Topics: Birth Weight; Body Mass Index; Cross-Sectional Studies; Female; Fetal Macrosomia; Gestational Age; Humans; Infant, Newborn; Malaysia; Maternal Age; Parity; Pregnancy; Retrospective Studies; Risk Factors; Sensitivity and Specificity; Sex Factors; Tertiary Care Centers; Weight Gain

To determine if shoulder dystocia can be predicted in babies born weighing 3.5 kg or more.. A case-control study nested in a perinatal database of 899 mothers and their babies who weighed 3.5 kg or more. All were term pregnancies and delivered vaginally. A case was defined as any baby that encountered shoulder dystocia at delivery. Controls were deliveries over the same period that were not complicated by shoulder dystocia. A logistic regression model was created with macrosomia, parity, previous delivery of more than 3.5 kg, diabetes in pregnancy, prolonged labor, prolonged second stage and instrumental delivery as the independent variables. The adjusted odds ratio and the receiver operator characteristics (ROC) curves were used to see if these variables, both individually and as a model, were associated with or were discriminative enough to predict shoulder dystocia; an ROC curve of more than 0.7 showing good prediction.. There were 36 cases of shoulder dystocia during the study period, an incidence of 4%. Previous delivery of more than 3.5 kg, prolonged labor and prolonged second stage were not associated with shoulder dystocia. Although diabetes and instrumental delivery were independently and significantly associated with shoulder dystocia their importance as a predictor became relevant only in the presence of macrosomia.. Macrosomia is the only reliable predictor of shoulder dystocia.

Topics: Birth Weight; Case-Control Studies; Dystocia; Female; Fetal Macrosomia; Humans; Incidence; Infant, Newborn; Logistic Models; Malaysia; Parity; Pregnancy; Risk Assessment; Risk Factors; ROC Curve; Shoulder

This study reviews the deliveries of macrosomic babies and their outcomes. A total of 330 macrosomic (birth weight > or =4 kg) cases were studied retrospectively from July 1999 to December 1999 in the Maternity Hospital of Kuala Lumpur. The variables studied included induction of labour, mode of delivery and the incidence of maternal and perinatal complications. Three hundred and thirty macrosomic infants were delivered during the period of study. Vaginal delivery was achived in 56% of the study cases. The percentage of vaginal delivery was higher among those who had induction of labour (63%) compared to the group without induction of labour (50%). Vaginal delivery was planned in 267 mothers and of these 69% achieved vaginal delivery. Twelve per cent of the macrosomic infants were delivered by elective caesarean section. Shoulder dystocia occurred in 4.9% of vaginal deliveries. Eighty-eight neonates were admitted to the special care nursery unit and 57% of these infants were delivered by elective caesarean section. Perineal trauma occurred in 26% of vaginal deliveries. Post-partum haemorrhage occurred in 32% of caesarean deliveries compared to 4% in vaginal deliveries. Two cases of stillbirths were documented but no maternal death occurred during the period of study. Vaginal delivery is the most frequent mode of delivery for a fetus weighing in excess of 4 kg and vaginal delivery should be attempted in the absence of contraindications, because vaginal delivery has less maternal morbidity compared to caesarean delivery. However, shoulder dystocia remains a significant complication of vaginal delivery for macrosomic fetuses.

Topics: Adult; Age Distribution; Cross-Sectional Studies; Delivery, Obstetric; Female; Fetal Macrosomia; Gestational Age; Humans; Infant, Newborn; Malaysia; Medical Records; Middle Aged; Obstetric Labor Complications; Parity; Pregnancy; Pregnancy Outcome; Retrospective Studies

Topics: Female; Fetal Macrosomia; Humans; Infant, Newborn; Malaysia; Obstetric Labor Complications; Pregnancy; Risk Factors