ChangesinDopplerUltrasound Parameters ofmiddleCerebral arteryversusSonographic Parameters forPrediction ofFetal Macrosomia AComparativeStudy
Mohamed Saber Khalil Abouzeid;
Abstract
Summary
M
acrosomicinfantsaswellastheirmothersareatincreasedriskforintrapartuminjury.Perinatalmortalityismorecommonamongthesefetuses.
Themostcommonlyaccepteddefinitionformacrosomiaisthatofbirthweightequaltoorexceeding4000g.AccordingtoACOG(2000),itisreasonabletoconsiderallnewborninfantsweighing4500gormoreasmacrosomic.Themostrecentstudiesreportedanincidenceof8.9%forfetuseswithmacrosomia(>4000g).
Enlargementofthesizeofthefetusmaybegeneralizedorconfinedtocertainparts:head,neck,thorax,abdomenorpelvis.Enlargementofthesizeofthefetusasawholemaybesymmetricalorasymmetrical.
Theetiologyoffetalmacrosomiaisbelievedtobemultifactorial.Etiologicfactorsincludegestationalage,diabetesmellitus,malesex,multiparity,maternalweightgainduringpregnancy,birthweightofapriormacrosomicinfant,ethnicityaswellasgeneticandcongenitaldisorders.
Manystudieshavelargelydefinedtheessentialroleofinsulin,insulinlikegrowthfactors(IGF-I&IGF-II),andtheirreceptorsinembryonicandfetalgrowth.Otherpotentialmechanismsoffetalsomaticovergrowthincludegeneticfactors,utero-placentalconstraints,thyroidandgrowthhormones,andleptin.
Sinceitsrecognition,macrosomiahasbeenoneofthecornerstonesofdiabeticfetopathy.Hyperglycemiaexistsinwomenwithpoorlycontrolleddiabetes,glucosecrossestheplacentabyfacilitateddiffusionandthefetusmaintainsalevelofabout70-80%ofthematernalglucoseconcentration.Thisresultsinacarbohydratesurplustothefetuswithsubsequenthyperinsulinemia.Fetalhyperinsulinemiacausesdirectgrowthstimulation,increasedcellularglucoseutilization,increaseddepositionanddecreasedmobilizationoffatandincreasedproteinproduction,thisleadstoovergrowthandthebirthofaneonatewithmacrosomia.
Fetalmacrosomiahasanimportanteffectonmaternalandfetalmorbidityandmortality.Maternalcomplicationsincludearrestdisorders,protractiondisorders,instrumentaldeliverywithmoreobstetriclacerations,postpartumhemorrhageandpuerperalinfection,cesareandeliveryandshoulderdystocia.Fetalcomplicationsincludebirthinjuries,asphyxialinjuries,neonatalhypoglycemia,andchildhoodandadolescentobesity.
Birthinjuriesincludemainlybrachialplexusinjuryandfractureclavicle.Brachialplexusinjuryresultsfromdownwardtractiononthebrachialplexusduringdeliveryoftheanteriorshoulder.Erb’spalsyfrominjurytothespinalnervesC5-6.
Accurateprenataldiagnosisofmacrosomiaisimportantforplanningandtimingofthemethodofdelivery.
Therearethreemajorstrategiesusedtopredictmacrosomiawhichareriskassessment,clinicalestimationoffetalweightandultrasonography.Thestrongestriskfactorismaternaldiabetes,whichresultsinatwo-foldincreaseintheincidenceofmacrosomia.Otherriskfactorsincludeprolongedgestation,obesityandmultiparity.However,34%ofmacrosomicinfantsareborntomotherswithnoidentifiableriskfactor.
Clinicalestimationoffetalweightincludesfundallevel,measurementofthegirthcircumferenceattheleveloftheumbilicusaswellasthemeasurementofsymphysial-fundalheight.Whenclinicalestimateswerecomparedwithsonographicestimatesoffetalweight,theresultswerecomparableandclinicalestimatesperformedfavorably.
Sonographicmethodsfordiagnosisofmacrosomiaweredevelopedinhopesofimprovingclinicalestimates.Measuredparametersinclude:headcircumference(HC),abdominalcircumference(AC),thighcircumference(ThC),femurdiaphysislength(FDL),weightestimate(WE)andbodyproportionality(HC/ACandFDL/HC).ThetruevalueofUltrasonographyinthemanagementoffetalmacrosomiamaybeitsabilitytoruleoutthediagnosis.Ultrasound-derivedfetalweightestimatesalonearenotsufficientgroundsfordecidingtherouteofdelivery.
Dopplerindicesinthemiddlecerebralarteries,thecerebroplacentalDopplerratioandumblicalarteryDopplerindicesarenotsignificantparametersindiagnosisofmacrosomia.
Preventivefactorsoffetalmacrosomiaincludereductionofpre-pregnancyweightandweightgainduringpregnancy,limitationofposttermpregnancyandcontrolofdiabetes.
Themanagementofpatientswithsuspectedfetalmacrosomiaiscontroversial.Electivecesareandeliveryandlaborinductionhavebeenproposedasinterventionstopreventmaternalandperinatalcomplications.
M
acrosomicinfantsaswellastheirmothersareatincreasedriskforintrapartuminjury.Perinatalmortalityismorecommonamongthesefetuses.
Themostcommonlyaccepteddefinitionformacrosomiaisthatofbirthweightequaltoorexceeding4000g.AccordingtoACOG(2000),itisreasonabletoconsiderallnewborninfantsweighing4500gormoreasmacrosomic.Themostrecentstudiesreportedanincidenceof8.9%forfetuseswithmacrosomia(>4000g).
Enlargementofthesizeofthefetusmaybegeneralizedorconfinedtocertainparts:head,neck,thorax,abdomenorpelvis.Enlargementofthesizeofthefetusasawholemaybesymmetricalorasymmetrical.
Theetiologyoffetalmacrosomiaisbelievedtobemultifactorial.Etiologicfactorsincludegestationalage,diabetesmellitus,malesex,multiparity,maternalweightgainduringpregnancy,birthweightofapriormacrosomicinfant,ethnicityaswellasgeneticandcongenitaldisorders.
Manystudieshavelargelydefinedtheessentialroleofinsulin,insulinlikegrowthfactors(IGF-I&IGF-II),andtheirreceptorsinembryonicandfetalgrowth.Otherpotentialmechanismsoffetalsomaticovergrowthincludegeneticfactors,utero-placentalconstraints,thyroidandgrowthhormones,andleptin.
Sinceitsrecognition,macrosomiahasbeenoneofthecornerstonesofdiabeticfetopathy.Hyperglycemiaexistsinwomenwithpoorlycontrolleddiabetes,glucosecrossestheplacentabyfacilitateddiffusionandthefetusmaintainsalevelofabout70-80%ofthematernalglucoseconcentration.Thisresultsinacarbohydratesurplustothefetuswithsubsequenthyperinsulinemia.Fetalhyperinsulinemiacausesdirectgrowthstimulation,increasedcellularglucoseutilization,increaseddepositionanddecreasedmobilizationoffatandincreasedproteinproduction,thisleadstoovergrowthandthebirthofaneonatewithmacrosomia.
Fetalmacrosomiahasanimportanteffectonmaternalandfetalmorbidityandmortality.Maternalcomplicationsincludearrestdisorders,protractiondisorders,instrumentaldeliverywithmoreobstetriclacerations,postpartumhemorrhageandpuerperalinfection,cesareandeliveryandshoulderdystocia.Fetalcomplicationsincludebirthinjuries,asphyxialinjuries,neonatalhypoglycemia,andchildhoodandadolescentobesity.
Birthinjuriesincludemainlybrachialplexusinjuryandfractureclavicle.Brachialplexusinjuryresultsfromdownwardtractiononthebrachialplexusduringdeliveryoftheanteriorshoulder.Erb’spalsyfrominjurytothespinalnervesC5-6.
Accurateprenataldiagnosisofmacrosomiaisimportantforplanningandtimingofthemethodofdelivery.
Therearethreemajorstrategiesusedtopredictmacrosomiawhichareriskassessment,clinicalestimationoffetalweightandultrasonography.Thestrongestriskfactorismaternaldiabetes,whichresultsinatwo-foldincreaseintheincidenceofmacrosomia.Otherriskfactorsincludeprolongedgestation,obesityandmultiparity.However,34%ofmacrosomicinfantsareborntomotherswithnoidentifiableriskfactor.
Clinicalestimationoffetalweightincludesfundallevel,measurementofthegirthcircumferenceattheleveloftheumbilicusaswellasthemeasurementofsymphysial-fundalheight.Whenclinicalestimateswerecomparedwithsonographicestimatesoffetalweight,theresultswerecomparableandclinicalestimatesperformedfavorably.
Sonographicmethodsfordiagnosisofmacrosomiaweredevelopedinhopesofimprovingclinicalestimates.Measuredparametersinclude:headcircumference(HC),abdominalcircumference(AC),thighcircumference(ThC),femurdiaphysislength(FDL),weightestimate(WE)andbodyproportionality(HC/ACandFDL/HC).ThetruevalueofUltrasonographyinthemanagementoffetalmacrosomiamaybeitsabilitytoruleoutthediagnosis.Ultrasound-derivedfetalweightestimatesalonearenotsufficientgroundsfordecidingtherouteofdelivery.
Dopplerindicesinthemiddlecerebralarteries,thecerebroplacentalDopplerratioandumblicalarteryDopplerindicesarenotsignificantparametersindiagnosisofmacrosomia.
Preventivefactorsoffetalmacrosomiaincludereductionofpre-pregnancyweightandweightgainduringpregnancy,limitationofposttermpregnancyandcontrolofdiabetes.
Themanagementofpatientswithsuspectedfetalmacrosomiaiscontroversial.Electivecesareandeliveryandlaborinductionhavebeenproposedasinterventionstopreventmaternalandperinatalcomplications.
Other data
| Title | ChangesinDopplerUltrasound Parameters ofmiddleCerebral arteryversusSonographic Parameters forPrediction ofFetal Macrosomia AComparativeStudy | Other Titles | قياس التغيرات فى دوبلرالشريان الدماغي الأوسط مقابل قياسات الموجات فوق الصوتية فى الكشف عن العملقة الجنينية | Authors | Mohamed Saber Khalil Abouzeid | Issue Date | 2015 |
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