巨大胎儿106例临床分析

目的 探讨巨大胎儿的预防、诊断和处理,降低巨大胎儿的发生率,更有效地指导优生优育.方法 回顾分析2000年10月～2005年10月5年间巨大胎儿病例,并随机抽取同期正常体重儿病例对照,比较两组在分娩方式、产后出血等方面有无差别.结果 5年间单胎分娩总数2562人次,其中巨大胎儿106例,占4.14%.巨大胎儿与同期正常体重儿在分娩方式、产后出血等方面有显著差别.结论 预防、减少巨大胎儿的发生,产前及时诊断巨大胎儿及产时合理处理是降低母婴并发症的重要措施.     

Beckwith-Wiedemann Syndrome

The Beckwith-Wiedemann syndrome (BWS) is a complex congenital disorder with omphalocele, macroglossia, and gigantism as its most common neonatal features. However, in individual cases, the phenotypic expression of this condition is variable. Antenatal diagnosis in previously unsuspected cases depends upon the identification of a number of specific ultrasonic findings. We report a case in which the antenatal diagnosis of BWS was made, and review the previously described cases, noting the specific ultrasonic findings that suggest the correct in utero diagnosis.     

肩难产发生的危险因素和临床特征的多中心分析

目的 探讨肩难产发生的危险因素和临床特征.方法 收集2008年1月至2013年9月,广州医科大学附属第三医院等5家医院住院的足月妊娠、单胎、头位并经阴道分娩的产妇共44 580例,其中发生肩难产116例(肩难产组),其余未发生肩难产者为对照组.对两组产妇的临床资料进行回顾性分析,包括年龄、身高、孕前体质指数(BMI)、孕期体质量增重值、孕周、孕次、产次、宫高、腹围、既往肩难产病史、分娩巨大儿、妊娠期糖尿病、糖尿病合并妊娠、过期妊娠及产程情况.结果 (1)44 580例产妇中发生肩难产116例,发生率为0.260％(116/44 580).肩难产组产妇年龄、孕前BMI、孕期体质量增重值明显高于对照组,两组比较,差异均有统计学意义(P＜0.01);两组产妇身高、孕周、孕产次、宫高及腹围分别比较,差异均无统计学意义(P＞0.05).(2)肩难产组产妇有肩难产病史(11.21％,13/116)、分娩巨大儿(13.79％,16/116)、糖尿病合并妊娠(7.76％,9/116)、过期妊娠(10.34％,12/116)、最大加速期延长(8.62％,10/116)及第二产程延长(7.76％,9/116)的发生率,分别与对照组[分别为(1.43％,636/44 464)、(1.48％,658/44 464)、(0.57％,252/44 464)、(1.15％,513/44 464)、(0.72％,322/44 464)、(0.65％,289/44 464)]比较,差异均有统计学意义(P＜0.05).(3)logistic回归分析显示,产妇年龄＞35岁(OR=1.116,95％CI为1.022～2.445)、孕前BMI＞27 kg/m2(OR=1.893,95％ CI为1.358～2.228)、孕期体质量增重值(＞20 kg)(OR=2.031,95％CI为1.749～ 3.231)、肩难产病史(OR=2.138,95％ CI为1.564～ 3.853)、分娩巨大儿(OR=3.276,95％CI为2.315～ 4.638)、糖尿病合并妊娠(OR=3.261,95％CI为2.237～ 4.943)、过期妊娠(OR=1.473,95％CI为1.003～ 2.721)、最大加速期延长(OR=2.022,95％CI为1.681～ 3.732)及第二产程延长(OR=1.943,95％CI为1.285～ 3.215),以上各项P值均＜0.05,是肩难产发生的危险因素.结论 高龄孕产妇(年龄＞35岁)、孕前BMI＞27 kg/m2、孕期体质量增重＞20 kg、肩难产病史、分娩巨大儿、糖尿病合并妊娠、过期妊娠、最大加速期延长及第二产程延长是肩难产发生的危险因素及临床特征.     

Third trimester ultrasound for fetal macrosomia: optimal timing and institutional specific accuracy

Purpose: To determine the performance of third trimester ultrasound in women with suspected fetal macrosomia.

Materials and methods: We performed a retrospective cohort study of fetal ultrasounds from January 2004 to December 2014 with estimated fetal weight (EFW) between 4000 and 5000?g. We determined accuracy of birth weight prediction for ultrasound performed at less than and greater than 38 weeks, accounting for diabetic status and time between ultrasound and delivery.

Results: There were 405 ultrasounds evaluated. One hundred and twelve (27.7%) were performed at less than 38 weeks, 293 (72.3%) at greater than 38 weeks, and 91 (22.5%) were performed in diabetics. Sonographic identification of EFW over 4000?g at less than 38 weeks was associated with higher correlation between EFW and birth weight than ultrasound performed after 38 weeks (71.5 versus 259.4?g, p?Conclusions: Identification of EFW with ultrasound performed less than 38 weeks has greater reliability of predicting fetal macrosomia at birth than measurements performed later in gestation. EFW to birth weight correlation was more accurate than previous reports.     

Perinatal outcome of pregnancies complicated with extreme birth weights at term

Objective: The objective of this study is to investigate whether an abnormal birthweight at term, either small for gestational age (SGA,??95th centile for gestational age), is a risk factor for perinatal complications as compared with birthweight appropriate for gestational age (AGA).

Methods: A population-based retrospective cohort analysis of all singleton pregnancies delivered between 1991 and 2014 at Soroka Medical Center. Congenital malformations and multiple pregnancies were excluded. A multivariable generalized estimating equation regression model was used to control for maternal clusters and other confounders.

Results: During the study period, 228,242 births met the inclusion criteria, of them 91% were AGA (n?=?207,652), 4.7% SGA, and 4.3% LGA. SGA significantly increased the risk for perinatal mortality (aOR 5.6, 95%CI 4.5–6.8) and low 5-min Apgar scores (aOR 2.2, 95%CI 2.0–2.4), while LGA did not. SGA and LGA were both significant risk factors for cesarean delivery. LGA was significantly associated with shoulder dystocia and post-partum hemorrhage (aOR =13.6, 95%CI 10.9–17.0, and aOR 1.7, 95%CI 1.2–2.6, respectively).

Conclusions: Extreme birthweights at term are significantly associated with adverse maternal and neonatal outcomes. As opposed to SGA, LGA is not independently associated with perinatal mortality.     

A new approach to predicting shoulder dystocia: fetal clavicle measurement

Background/aim This study aimed to evaluate the relationship between second- and third-trimester clavicle lengths and birth weight and shoulder dystocia.Materials and methods This prospective observational study included 181 patients who presented to the Private Etlik Lokman Hekim Hospital for routine pregnancy visits between March 2019 and March 2020. In addition to routine pregnancy examinations, the patients also underwent ultrasonography twice at weeks 20–23 and 33–36 to determine the length of the fetal clavicle. The patients were evaluated for shoulder dystocia in the second stage of labor. The birth weight of the neonates was recorded. The primary objective of this study was to establish the relationship between third-trimester clavicle length and shoulder dystocia.Results Fetal clavicle length increases in the second trimester with the advancing gestational week but does not significantly change in the third trimester. We did not observe any significant difference for second trimester clavicle length between the type of delivery, birth weight, or shoulder dystocia. Moreover, we did not observe any significant difference for third trimester clavicle length between types of delivery. However, we found a significant relationship between third trimester clavicle length and birth weight and shoulder dystocia. The median third-trimester clavicle length was 39.5 mm (range: 30.7–43.9) in neonates who did not develop shoulder dystocia and 42.5 mm (range: 41.4–43.1) in the 3 neonates who developed shoulder dystocia. The third-trimester clavicle length cut-off for shoulder dystocia was calculated as 41.35 mm (sensitivity: 100.00%, specificity: 83.82%, accuracy: 84.5%). The third-trimester clavicle length cut-off for macrosomia (defined as birth weight of ≥4100 g) was 40.75 mm (sensitivity: 87.50%, specificity: 77.56%, accuracy: 78.05%).Conclusion Third-trimester fetal clavicle length, an important component of biacromial diameter, as measured by ultrasonography, is a practical and significant method for predicting macrosomia and shoulder dystocia.     

Pre-Pregnancy Body Mass Index and Risk of Macrosomia and Large for Gestational Age Births with Gestational Diabetes Mellitus as a Mediator: A Prospective Cohort Study in Central China

This study aimed to examine the risk of macrosomia and large for gestational age (LGA) births in relation to maternal pre-pregnancy body mass index (BMI) status mediated through gestational diabetes mellitus (GDM). This prospective study included 34,104 singleton pregnancies at 8–14 weeks of gestation. The interesting outcomes were macrosomia (≥4000 g) and LGA (≥90th percentile). Mediation analyses were conducted using log-binomial regression adjusted for age, education, parity, fetal sex, and gestational weight gain. The proportion mediated was estimated based on the risk difference scale, and the E-value was utilized to assess potential confounders. Overall, 15.9% of women had GDM, and there were 4.0% macrosomia and 9.9% LGA births. The proportion mediated by GDM on macrosomia was up to 40% among obese women, and the estimate of the total effect was 6.18 (95% CI: 5.26–7.26), of the natural direct effect was 4.10 (95% CI: 3.35–4.99), and of the natural indirect effect was 1.51 (95% CI: 1.31–1.76). Likewise, among overweight women, the proportion mediated by GDM on macrosomia was up to 40%. Furthermore, consistent findings were evident for the outcome of LGA births. Pre-pregnancy overweight/obesity increased the risk of macrosomia and LGA births independently and partly mediated by GDM.     

97例巨大胎儿分析

目的：探讨巨大胎儿的分娩方式，降低母儿并发症。方法：回顾分析97例巨大胎儿的分娩方式及并发症，并与单胎正常体重儿分娩方式进行比较。结果：巨大胎儿中副宫产组较阴道分娩组新生儿窒息率明显降低，巨大胎儿与正常体重儿相比难产率明显升高。结论：对巨大胎儿应避免困难的阴道助产，适当放宽剖宫产指征。