Risk factors and obstetric complications associated with macrosomia.

OBJECTIVE: Macrosomia is associated with adverse maternal outcomes. The objective of this study was to characterize the epidemiology of macrosomia and related maternal complications. METHOD: Live births (146,526) were identified between 1995 and 1999 in the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR) database. Bivariate and multivariate analyses were performed for risk factors and complications associated with macrosomia (birth weight >4500 g). RESULT: Male infant sex, multiparity, maternal age 30-40, white race, diabetes, and gestational age >41 weeks were associated with macrosomia (p<0.001). In bivariate and multivariate analyses, macrosomia was associated with higher rates of cesarean birth, chorioamnionitis, shoulder dystocia, fourth-degree perineal lacerations, postpartum hemorrhage, and prolonged hospital stay (p<0.01). CONCLUSION: Macrosomia was associated with adverse maternal outcomes in this cohort. More research is needed to determine how to prevent complications related to excessive birth weight.     

B超测量胎儿腹径在巨大儿预测中的应用--附168例分析

目的 探讨一种Ｂ超预测巨大儿物简便、实用的方法。方法 回顾性分析１９９４年１月 １９９８年１２月间出生的巨大儿共１６８例。结果 胎儿腹径「ＡＤ＝（ＴＡＤ＋ＡＰＡＤ）／２」≥１１０ｍｍ者１４５例,预测巨在儿符合率为８６．３１％。与ＡＣ、ＡＤ＋ＢＰＤ、ＡＤ＋ＦＬ、ＡＤ＋ＢＰＤ＋ＰＬ相似,优于ＢＰＤ、ＦＬ、ＢＰＤ＋ＦＬ及宫高＋腹围。结论 Ｂ超测量胎儿腹径预测巨大儿简便、实用、准确,值得临床推广应用。     

巨大儿临床预测方法的局限性探讨

目的分析常用的几种巨大儿产前临床预测方法的应用价值。方法将2000年1月1日至2005年3月31日在北京大学第三医院妇产科进行产前检查并分娩巨大儿的273例孕妇临床资料与随机抽取的同期单胎分娩正常体重儿的135例孕妇临床资料作对比分析。采用统计学方法对临床常用巨大儿预测方法包括B超综合指标估算胎儿体重(estimated fetal weight,EFW)法、B超双指标估算法、胎儿双顶径(biparietal diameter,BPD)与股骨长(femur length,FL)之和]、B超单一指标估算法(胎儿腹围、股骨长)、临床宫高与腹围之和法以及经验性临床评估法进行评价。结果(1)巨大儿组与非巨大儿组孕妇年龄无统计学差异,但身高和终止妊娠孕周均有统计学意义[(163.0±5.47)cm和(160.0±4.7)cm;(39.7±1.2)周和(39.1±1.1)周,P<0.01]。(2)临床常用的巨大儿预测指标及不同界值的预测价值,EFW法灵敏度为38.1%,特异度为96.4%。B超双指标估算法(BPD+FL≥17 cm)灵敏度为54.0%,特异度为83.8%;当界值取16.5 cm时,灵敏度为88.8%,特异度为55.9%;B超双指标估算法的AC+FL≥42.5 cm时,灵敏度为90.8%,特异度为82.9%。B超单一指标法,以AC≥35 cm为界定值时其灵敏度为95.0%,特异度为71.0%;以38 cm为界定值时灵敏度为31.0%,特异度为99.1%。B超单一采用FL指标,以7.5 cm为界定值时灵敏度为49.8%和,特异度为82.0%。临床宫高与腹围之和法的界定值为≥140 cm时,其灵敏度为77.9%特异度为77.5%。经验性临床评估法灵敏度为46.3%特异度为96.6%。(3)各预测指标的ROC曲线下面积:EFW法0.906;B超双指标估算法中,BPD+FL之和0.795;AC+FL之和0.914;B超单一指标估算法中,AC 0.904,FL 0.752;临床宫高腹围之和0.862。(4)对于各个独立参数采用Logistic多因素回归分析,求得概率(P)方程及P的ROC曲线下面积为0.938。结论本研究显示了在某些病例中临床上预测巨大儿方面仍然有不可预测性。但各项指标单独应用时均有较大局限性至今尚无一种方法可以准确预测巨大儿。胎儿腹围与股骨长之和可能成为一个临床价值较好的预测指标。综合孕妇身高、终止孕周、胎儿腹围、宫高腹围和多参数分析可提高预测的准确性,降低漏诊率。     

Tracheal rupture in complicated delivery: A case report and review of the literature

A case of distal tracheal rupture is described, literature review reveals two previously reported cases of neonatal distal tracheal rupture, as well as 14 cases of anterior subglottic rupture. All patients had shoulder dystocia, and 59% had associated brachial plexus injury. Delayed diagnosis (>3 days) was common in the distal tracheal group (66%), compared to 0% in the anterior subglottic group. The 2 distal tracheal rupture patients were initially managed conservatively, but ultimately required open repair. Distal tracheal rupture is exceedingly rare and more difficult to diagnose and manage than the more common anterior subglottic rupture.     

巨大儿的产前预测及对母婴结局的影响

目的观察分析巨大儿产期预测对母婴结果的影响。方法选取我院从2011年3月至2012年3月收治的巨大儿共120例。随机将患者分为预测组和非预测组。其中预测组患者共55例产妇,非预测组共65例产妇。结果预测组产妇的剖宫产率为41.8%,明显要低于未预测组的53.8%,两组对比有显著性差异(P<0.01)。另外,两组产妇在分娩过程中,预测组发生的并发症明显要少于未预测组,其中预测组发生胎儿宫内窘迫、肩难产、产后出血以及产后尿潴留等均明显要少于未预测组产妇,两组对比有显著性差异(P<0.01)。结论产期预测能有效减少剖宫产率,防止分娩过程中母婴发生各种的并发症,减少非产妇以及胎儿的影响。     

Effects of gestational weight gain on pregnancy complications

Introduction and objective

Gestational weight gain (GWG) has been reported to be associated with pregnancy outcomes. The aim of this study was to evaluate the effects of GWG on maternal and birth complications.

The Diagnosis of ‘Pathological Hyperglycaemia’ in Gestational Diabetes in a High Risk Obstetric Population

In order to define a level of ‘pathological hyperglycaemia’, i.e. glucose intolerance that predicts perinatal morbidity among the obstetric population, 100 g glucose tolerance tests (GTTs) were performed in 660 patients attending for antenatal care at the University Hospital in Jeddah. The results were analysed in two ways: (1) patients were stratified according to the number of abnormal glucose values on the GTTs and (2) patients were placed into one of three groups according to the 100 g GTT diagnostic criteria, i.e. normal (non-GDM), abnormal with fasting blood glucose (FBG) ≥5.8 mmol l⁻¹ (GDM), and abnormal with FBG <5.8 mmol l⁻¹ (gestational induced hyperglycaemia, GIH). Although there was a stepwise association between fetal/maternal morbidity with increasing number of abnormal glucose values, no level of glucose intolerance could be defined as a threshold level for normal response. However, when stratified by FBG, GDM patients were significantly heavier (78.5 kg ± SD 14.9), had a higher incidence of both macrosomia (27.5 %) and operative delivery (25.3 %) than the other two groups (14.7 %, 14.3 %, and 15.4 %, 12.8 % in the non-GDM and GIH, respectively). It is suggested that among patients with abnormal GTT results a FBG ≥ 5.8 mmol l⁻¹ identifies a threshold for true ‘pathological hyperglycaemia’.