Gokulapriya, K (2013) Umbilical cord thickness, fetal fat layer, and Shoulder pad thickness as predictors of Macrosomia in fetus of women with gestational and pregestational Diabetes Mellitus. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Diabetes mellitus is one of the commonest problem encountered in pregnancy. In Asia the incidence is around 5-8 %. It affects both the mother and the fetus in many ways. Infant of diabetic mother are more prone to be macrosomic which is a major cause of fetal and maternal morbidity. Macrosomia means large sized fetus or neonate. Fetal macrosomia is defined as birth weight of greater than 4000g or greater than 90th percentile for gestational age after correcting for neonatal sex and ethnicity. Fetal macrosomia complicates more than 10 % of all pregnancies. Macrosomia is associated with significant fetal, neonatal and maternal risks. Macrosomia increases the risk of shoulder dystocia, brachial plexus injury, skeletal injuries in the fetus. Maternal complications are increased incidence of operative delivery, postpartum hemorrhage, third or fourth-degree perineal lacerations. In order to avoid the complications associated with delivery of macrosomic fetuses, it is prudent to antenatally predict macrosomia such that effort can be taken to provide a modified intrapartum care. The obstetrician’s intention in anticipating macrosomia is for selecting cases wherein caesarean section is warranted to avoid maternal and fetal risk due to traumatic delivery and for a vigilant intra partum management. The antenatal detection of macrosomia has many pitfalls. The traditional technique is calculating Estimated Fetal Weight (EFW) using fetal biometric variables like biparietal diameter, femur length, abdominal circumference. But estimated fetal weight is not a reliable indicator of macrosomia or its associated intrapartum complications. To overcome this difficulty clinicians proposed the use of soft tissue measurement- including shoulder pad thickness, cheek-tocheek diameter, umbilical cord thickness, fetal fat layer, inter-ventricular septum thickness, etc. The purpose of this prospective study was to evaluate the diagnostic value of ultrasonographic measurement of fetal umbilical cord thickness, fetal fat layer, and shoulder pad thickness for prediction of fetal macrosomia during intrapartum period. AIM: To evaluate the sonographic measurement of umbilical cord thickness, fetal fat layer, and shoulder pad thickness as predictors of macrosomia in fetus of women with gestational and pre gestational diabetes mellitus. MATERIALS AND METHODOLOGY: This study was conducted for a period of one year from 2011 to 2012, at Institute of Obstetrics and Gynaecology, Egmore. Antenatal women with GDM or pre GDM, diagnosed by OGTT, dates confirmed by early scans, in their late third trimester(35-36 weeks), who attended Antenatal OPD at IOG, were recruited prospectively into the study. Those who met the inclusion criteria were invited to participate in the study. Ethical committee clearance was obtained for the study and informed written consent was obtained from all the participants. Inclusion Criteria: - Pregnant women with GDM / DM in late third trimester (35-36 weeks), - Reliable dates confirmed by dating scan, - Three vessel umbilical cord. Exclusion Criteria: - Multiple pregnancy, - Known anomalous baby. Proforma were filled after obtaining consent from each patient. Participants underwent a third trimester scan .Three extra measurements – Umbilical cord thickness, Fetal fat layer and Shoulder pad thickness, were measured in addition to the normal examination. These measurements took not much of an extra time. The abdominal circumference and estimated fetal weight were part of routine scan. The measurements were performed by sonologist at the department of radiology, Institute of Obstetrics and Gynaecology, Egmore with 3.5 MHz abdominal probe. Fetal anthropometric parameters, biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL), were measured in all fetuses. EFW was obtained using the formula proposed by Hadlock et al. SUMMARY: 405 antenatal mothers with GDM or pre GDM were included in our study. This study was conducted to analyse the usefulness of soft tissue measurements in predicting macrosomia in pregnancy complicated by gestational and pre gestational diabetes. In addition, the association between maternal characteristics and macrosomia were studied. • Among the maternal characteristics increased maternal age, parity and BMI were significantly associated with macrosomia. • Among the ultrasound parameters, a cut of abdominal circumference ≥ 35 cms, fetal fat layer ≥ 5mm, shoulder pad thickness ≥ 12 mm had good sensitivity, specificity and negative predictive value as predictors of macrosomia. Umbilical cord thickness greater than 90th percentile had good negative predictive value. • 70.2 % of macrosomic fetus needed caesarean section. Thus, macrosomia increases the rate of caesarean section. • 12.3 % of deliveries of macrosomic fetus were complicated by shoulder dystocia as against 1.1% among non macrosomia group. The shoulder dystocia is much more common in macrosomic fetus than non macrosomic fetus. CONCLUSION: Macrosomia is every obstetrician’s nightmare and hence clinicians are in constant search for better methods of prediction. Fetal fat layer and shoulder pad thickness are good predictors of fetal macrosomia. In the assessment of risk of macrosomia in addition to the ultrasonographic measurements the clinical risk factors must be considered. Further studies are needed to evaluate the clinical value of incorporating these soft tissue measurements in formulas for estimation of fetal weight.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prospective study ; sonographic measurement ; umbilical cord thickness ; fetal fat layer ; shoulder pad thickness ; predictors ; macrosomia ; fetus of women ; gestational ; pregestational diabetes mellitus. And pregestational diabetes mellitus. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 07:44 |
| Last Modified: | 13 Dec 2017 03:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4060 |
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