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Article
The frequency of hypoglycemia in macrosomic neonates in Amarah governorate, Iraq

Author: Sabah H. A. Al-Atwani C.A.P.B**, Ali A. Obaid C.A.B.P, F.I.C.M.S**
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2015 Volume: 11 Issue: 1 Pages: 78-80
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Neonatal macrosomia is defined as a birth weight of more than 4000 g. Significant maternal and neonatal complications can result from the birth of macrosomic infants like hypoglycemia and birth injuries.Objectives: To determine the frequency of hypoglycemia in neonates with macrosomia in Amarah, IraqMethods: The study involved 146 macrosomic newborn neonates delivered in 2 maternity hospitals in Amarah, Iraq during a period from June 2011 to June 2014.Results: Hypoglycemia was observed in 16% of neonates affected by macrosomia. Maternal diabetes was the most common cause of fetal macrosomia (28%).Our results were compared with those from other parts of the world.Conclusion Macrosomia is associated with increase rate ofneonatal hypoglycemia especially among infants of diabeticmothers.


Article
The Correlation Between Lipid Profiles and Macrosomia in Diabetic Pregnancies

Author: Miami A. Ali,
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 2 Pages: 40-44
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Maternal diabetes is an important risk factor for development of fetal macrosomia. Studies showed that elevated lipid profile levels in third trimester of the diabetic pregnant women may predict the macrosomia of the newborn babies. Objective: To assess the relationship of elevated lipid profile levels in third trimester with the occurrence of macrosomia in diabetic pregnant women. Study design: A case control study. Setting: Carried out at AL- Yarmouk Teaching Hospital/ Department of Obstetrics and Gynecology for one year from March 2011 to March 2012. Patients and Methods: A hundred pregnant women were enrolled in this study. Fifty women with diabetes mellitus (twenty six women with gestational diabetes mellitus, sixteen women had type 1diabetes mellitus, and eight women had type 2diabetes mellitus) and fifty healthy pregnant women taken as a control. Both groups were in the third trimester. The two groups were comparable for maternal age, gestational age, parity and body mass index. Blood samples were taken for measurement of serum lipid and sugar profile from both groups and correlated with the occurrence of macrosomia. Results: There were a significant and direct correlation between macrosomia and total cholesterol, triglyceride, low density lipoprotein and very low density lipoprotein cholesterols in diabetic groups (Gestational diabetes , type 1& type 2 DM ) in comparison to the control group (p=0.0275, 0.0001, 0.031, 0.0001). There was a significant inverse correlation between macrosomia and high density lipoprotein cholesterol in diabetic group in comparison to the control group (p=0.043). Conclusion: Macrosomia in newborns of diabetic pregnant women is associated significantly with maternal dyslipidemia during the third trimester of pregnancy


Article
Fetal Parameters and Early Evidence of Fetal Macrosomia in Prepregnancy Diabetic Women

Authors: Hala A. G. AL Rawi --- Ban Hadi --- Najlaa Hanon
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2018 Volume: 17 Issue: 2 Pages: 75-79
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Diabetes in pregnancy with macrosomia is an important risk factor for neonatal morbidity and mortality. Prediction ofmacrosomia is significantly improved by adding ultrasound to clinical findings. Objective: For earlier detection of macrosomia inprepregnancy diabetic mothers using fetal growth profile including biparietal diameter, femoral length, and also abdominal circumference (AC). Patients and Methods: A historical prospective cohort study was performed at National Endocrine and Diabetic Center in addition to theObstetrics and Gynecology Department at Al‑Yarmouk Hospital for 2 years, from September 2014 to 2016. A hundred and sixty pregnantwomen were enrolled in this study, 80 of them with a history of prepregnancy diabetes mellitus were taken as a patient group and the other 80 pregnant women with a compatible gestational age and without a history of diabetes mellitus were taken as a comparison group. Abdominalultrasound was done for patients in both groups at 20, 28, and 36 weeks of gestation and then birth weight was measured for each. Results werecompared between two groups. Results: The incident of macrosomia was 30% in patient group and 10% in comparison group. Regarding earlyprediction of macrosomia by ultrasound using biparietal diameter, femoral length, and AC, the results of the current study revealed that those macrosomic babies have higher femoral length, AC but not biparietal diameter in comparison with babies of average weight using ultrasound performed at 20‑week gestation and repeated at 28 and 36 weeks. Conclusion: In diabetic mother, fetal macrosomia can be predicted by ultrasound during pregnancy as early as 20‑week gestation.


Article
Maternal and Neonatal Outcomes in Diabetic and Non-Diabetic Women with Macrosomic Births
تضخم الجسم عند حدیثي الولادة:حصیلة الأم وحدیث الولادة في أمھات مصابات بالسكر وغیر مصابات بالسكر

Author: Tala Anwar Al-Awqati
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2012 Volume: 25 Issue: 1 Pages: 15-18
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Macrosomia is generally defined as birth weight of least 4000 g. Macrosomia increases the frequency of obstetric complications such as shoulder dystocia, perineal laceration or cesarean section and the risk of brachial plexus palsy, asphyxia and cerebral hemorrhage in newborn. Objective: The aim of this retrospective study is to examine the maternal and neonatal outcomes of macrosomic babies at Al -Yarmok Teaching Hospital, and to compare the outcomes in infants of diabetic and non-diabetic mothersPatients and methods: At Al-Yarmouk Teaching Hospital, gynecology and obstetric department, in cooperation with special care baby unit (SCBU) a retrospective analysis was conducted in a one-year period (from November 2009 to November 2010). The study group was all live born, singleton neonates with a birth weight of equal or more than 4000 g. The information was taken from the medical records of the mother and the infant The data analysis was performed with Medcalc statistical software. Statistical significance was set at p<0.05. The outcomes were compared between the diabetic and non-diabetic groups using Fisher exact test.Results: During the study period, there were 8254 deliveries. Macrosomic infants were 165, representing 2%. The mean birth weight (standard deviation) of all macrosomic infants was 4363g (325g.) Of the165 macrosomic infants, 112(67.9%) born to non-diabetic mothers, while 53(32.1%) born to diabetic mothers. Seventy two infants of the total group (43.6%) were above 4500g, fifty three of them in the non-diabetic mothers(47.3% of the this group) . The diabetic mothers were significantly older than non- diabetic mothers (p<0.03). The mean gestational age at delivery(standard deviation) were 39.58weeks(SD0.87), 39.58weeks(SD 1.11) in the non-diabetic and diabetic mothers respectively, however, the difference was statistically not significant (p>0.58).Seventy percent of the non-diabetic group delivered by caesarean section, and 80% of the diabetic group delivered by caesarean section (p>0.14). After vaginal deliveries, there were four cases of vaginal tear, all of them seen in the non-diabetic mothers. Episiotomy was significantly higher in non-diabetic group (p=0.028). Hypoglycemia was significantly higher in the non-diabetic mothers (p=0.02), while the duration of hospitalization more than three days was significantly higher in the infant of diabetic mothers (p=0.05). Respiratory distress was seen in about quarter of the infants of diabetic mothers, in spite of 15% only of non-diabetic mothers had this complication, but this difference was not significant when evaluated by t-test(p=0.19). Birth trauma including shoulder dystocia, Bells palsy and fracture clavicle were seen in 4 infants, 2 in each group. The heavier infants were delivered by caesarean section more than those below4500g. Conclusion: Macrosomic infants represent a risk group for adverse neonatal outcome and maternal morbidities, regardless the diabetic status of the mother. In studied group, the hypoglycemia was higher in the infant of non-diabetic mothers than those of diabetic mothers. Our macrosomic infants tend to be heavier than what found in the literatures.

الخلاصة: تضخم الجسم یعرف بأنه الوزن الولادي أكثر من ٤٠٠٠ غ ا رم. وهذا یؤدي الى زیادة التعقیداتالولادیة أمثال تعسر ولادة الكتف، تمزق المنطقة العجانیة، زیادة نسبة العملیات القیصریة ونسبةشلل الظفیرة الخیشومیة، الاختناق والنزف داخل الدماغ.الهدف من الد ا رسة: الد ا رسة الاسترجاعیة هدفها هو فحص حصیلة الأم وحدیث الولادة بعد ولادة طفلضخم الجسم في مستشفى الیرموك التعلیمي ومقارنة حدیثي الولادة في أمهات مصابات بالسكروأمهات غیر مصابات بالسكر.الطریقة:- في مستشفى الیرموك التعلیمي وبالتعاون بین قسم النسائیة والتولید مع قسم رعایة حدیثيالولادة، قمنا بد ا رسة استرجاعیة خلال سنة حیث تم الرجوع إلى سجلات المرضى الذین هم أكثرمن ٤٠٠٠ غ ا رم كوزن ولادي وتم تحلیل النماذج باستعمال ب رنامج مدكالك وتم استعمال فحصفشر.النتائج : - خلال فترة الد ا رسة كان هنالك ٨٢٤٥ ولادة، منهم ١٦٥ حدیث ولادة ذات حجم متضخم٦٧.٩ %) ولدوا من أم غیر مصابة ) ٣٢٥ غ ا رم، ١١٢ ± ویمثلون ٢% معدل الوزن كان ٤٣٦٣٣٢ %) ولدوا من ام مصابة بالسكر، كان معدل عمر الأمهات المصابات ) بالسكر، بینما ٥٣بالسكر أعلى من الغیر مصابات بالسكري. ٦٨ % من الأمهات الغیر مصابات بالسكر تمتالولادة عن طریق عملیة قیصیریة في حین كانت هذة النسبة ٧٩.٣ % في الأمهات المصاباتبالسكري. كانت هنالك أربع حالات تمزق عجانیة. نسبة هبوط السكر كانت أعلى في المجموعةغیر المصابة بالسكر وبدرجة ذات قیمة إحصائیة. حالات الإصابة المیكانیكیة وتشمل تعسر ولادةالكتف،شلل الظفیرة الخیشومیة، شلل العصب السابع المؤقت وكسر عظم الترقوة كانت موجودة فيأربعة حالات اثنان في كل مجموعة.الاستنتاج :- حدیثو الولادة المصابون بتضخم الجسم یمثلون مجموعة قابلة لنتائج خطیرة من حیث الأموالرضیع وبغض النظر كون الأم مصابة بالسكر أو غیر مصابة.


Article
Fetal macrosomiaMaternal and Perinatal outcome

Authors: Samar Daoud Sarsam** (C.A.B.O.G) سمر داوود سرسم --- Raida Muhammed Al-Wazzan* ( C.A.B.O.G) رائد محمد الوزان
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 1 Pages: 50-55
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Fetal macrosomia represent a continuing challenge in obstetrics and increasing in it's occurrence as well as it is associated with maternal and perinatal complications.Objective: To determine the maternal and perinatal outcome related to fetal macrosomia.Design: A prospective case control study.Patients and methods: (10th March-31st May, 2006A prospective case control study had done over the period from 10th March to 31st May, 2006 in Al-Batool maternity teaching hospital in Mosul city. The study group consisted from 633 singleton alive newborns with gestational age ≥37weeks weighing 4000 grams and heavier and mothers of these newborns compared with control group which consisted from 4155 singleton alive newborn with gestational age ≥37weeks weighing 2500-3999 grams and mothers of these newborns. The obstetrical outcome variables which compared between the two groups include mode of delivery, indication of caesarean section and maternal and perinatal complications.Results: Macrosomic newborns (≥4000grams) delivered in this study account for (12.45%) of total deliveries. Newborns with a birth weight of ≥4500grams constitute 2.65% from all deliveries. Male Newborns (65.24%) was higher and statistically differed among the study group (p value=0.001).Instrumental vaginal delivery (P value=0.010,Odd ratio: 2.12, 95% CI: 1.19-3.76) and cesarean section delivery (P value=0.000,Odd ratio:1.63, 95% CI: 1.34-1.98), mainly the emergency cesarean section (18.79%), were significantly different among the study group. Failure of progress of labour and cephalopelvic disproportion were the main indications in study group and showed statistical significant difference between the two groups.Among the study group, there was neither maternal death nor uterine rupture but there was higher occurrence of postpartum hemorrhage, genital tract trauma and shoulder dystocia which were significantly different when it compared with control group. Erb's palsy was the main perinatal complication and was statistically different among macrosomic group (P value=0.000). Conclusion: Fetal macrosomia was associated with higher rate of instrumental vaginal delivery and caesarean section mainly due to failure of progress of labour and cephalopelvic disproportion. There were higher rate of postpartum haemorrhage, genital tract trauma as well as shoulder dystocia with neither maternal death nor uterine rupture in study group. Among macrosomic newborn, Erb's pulsy was the main perinatal complication.


Article
Antepartum Detection of Macrosomic Fetus Clinical Versus Sonographic Including Humeral Soft Tissue Thickness
اكتشاف الجنين ذو الجسم الضخم : مقارنة الفحص السريري مع الفحص بالامواج فوق الصوتية من ضمنها قياس سمك الأنسجة الرخوة لمنطقة العضد

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Background: Neonatal mortality rates decrease with increasing birth weight until approximately 4000g, after which mortality increases. Maternal diabetes and obesity are among the predisposing factors for fetal macrosomia for which there are many fetal and maternal consequences like increasing incidence of birth injuries and caesarean section rates respectively.Objective: To compare clinical & sonographic estimation of birth weight using Hadlock’s (1) equation with other estimation technique that involve measurement of fetal humeral soft tissue thickness to identify newborns with excessive birth weight of at least 4000 grams. Patients & Methods: This study was conducted at the department of Gynaecology & Obstetrics in Al-Yermouk Teaching Hospital, Baghdad, Iraq. Ninety pregnant women were studied. They had gestational ages of 37 weeks or more and a suspicion of fetal macrosomia based on the presence of one or more of certain risk factors. About 24 hours prior to delivery of the fetus clinical estimation of fetal body weight using Leopold’s manoeuvre was done followed by sonographic fetal weight estimation using Hadlock’s (1) equation. Fetal humeral soft tissue thickness was measured by ultrasound three times and an average of the three readings was taken. Then a comparison of the three methods mentioned above was done regarding their validity in predicting fetal macrosomia. Results: Sonographic fetal humeral soft tissue thickness correlates with birth weight and found to be higher in macrosomic than the non-macrosomic newborns (14.35mm versus 11.6mm) and the difference was statistically significant (P value <0.001). The sonographic fetal humeral soft tissue thickness measurement was more sensitive in predicting fetal macrosomia than the sonographic fetal weight estimation (87.2 versus 75%) but less specific (74.2 versus 86%). The clinical estimation has the lowest accuracy in predicting fetal macrosomia compared with sonographic fetal weight estimation and sonographic fetal humeral soft tissue measurement. Conclusion: The sonographic measurement of fetal humeral soft tissue thickness positively correlates with newborn birth weight. It is more accurate than the clinical fetal weight estimation in predicting fetal macrosomia. On the other hand it is more sensitive but less specific than the sonographic fetal weight estimation using Hadlock’s (1) equation in predicting fetal macrosomia. Keywords: Fetal Macrosomia, humeral soft tissue thickness.

الهدف من البحث: الغرض من هذه الدراسة مقارنة الفحص السريري والفحص بالأمواج فوق الصوتية باستعمال معادلة هادلوك (1) لقياس وزن الجنين مع طريقه جديدة وهي قياس سمك الأنسجة الرخوة لمنطقة العضد للجنين باستعمال جهاز الفحص بالأمواج فوق الصوتية لغرض اكتشاف المواليد ذو الجسم الضخم والذين يكون وزنهم عند الولادة 4000 غرام على الأقل. التصميم: دراسة حالة مسيطرة موقع البحث: مستشفى اليرموك التعليمي – قسم التوليد والطب النسائي طريقة البحث: اشتملت الدراسة على فحص90 امرأة حامل عمر حملهن 37 أسبوع أو أكثر ولديهن احتمال ضخامة جسم الجنين اعتماداً على وجود عامل خطورة واحد أو أكثر، خلال أربعه وعشرين ساعة من الولادة تم فحص الحوامل فحص سريري وبطريقه ليوبولد لتقدير وزن الجنين ثم حساب وزن الجنين بواسطة الفحص بجهاز الأمواج فوق الصوتية وباستعمال معادلة هادلوك (1) ثم تم قياس سمك الأنسجة الرخوة لمنطقة العضد للجنين باستعمال جهاز الأمواج فوق الصوتية ثلاث مرات وأخذ ألمعدل، تم إجراء المقارنة بين الطرق الثلاثة المذكورة آنفا فيما يخص الطريقة الأكثر فاعليه في اكتشاف الجنين ذو الجسم الضخم. ألنتائج: أظهرت النتائج إن قياس سمك الأنسجة الرخوة لمنطقة العضد بجهاز الأمواج فوق الصوتية يتناسب طردياً مع وزن الجنين وانه أعلى في الأجنة ذوي الأجسام الضخمة (14.35ملم) عنه في ألأجنة ألاعتيادية ألوزن (11.6 ملم)، كما أظهرت النتائج ان قياس سمك الأنسجة الرخوة لمنطقة العضد بجهاز ألأمواج فوق الصوتية أكثر حساسية من حساب وزن الجنين بالأمواج فوق الصوتية (87.2 مقابل 75%) ولكنه أقل خصوصية في اكتشاف ضخامة جسم الجنين قبل الولادة (74.2 مقابل 86%)، كذلك تبين إن تقدير وزن ألطفل بالفحص السريري يعتبر ألأقل دقه في حساب وزن الطفل من كلتا الطريقتين المذكورتين آنفاً ألاستنتاج: إن قياس سمك الأنسجة الرخوة لمنطقة العضد بجهاز ألأمواج فوق الصوتية أكثر دقه من تقدير وزن الجنين بالفحص السريري كما انه أكثر حساسية من حساب وزن الجنين بالأمواج فوق الصوتية ولكنه أقل خصوصية في اكتشاف ضخامة جسم الجنين قبل الولادة. كلمات ألمفتاح: الجنين ذو الجسم الضخم ، سمك ألأنسجة ألرخوة لمنطقة العضد

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