estimation echographique du poids foetal a terme: Proposition d'un score predictif d'un poids superieur a 4500 g.

Estimation of fetal weight at term is essential because of risks of macrosomic infant delivery. The purpose of this study is to assess sonographic prediction of macrosomia and especially in fetal weight °> 4500 g Material and method: in a retrospective study on one year period, we analyzed sonography of 214 pregnant women at term having delivered macrosomic infants. From sensitivity, specificity and VPP found for each fetal measurement [abdominal transverse diameter ATD, femur length: FL, and biparietal diameter BPD] we tried to determine the best thresholds values that permit to suspect fetal weight more than4500g. sensitivity of ATD °> 100 mm, FL °> 76mm and BPD°> 94 mm in prediction of macrosomia were: 70,5%, 56% and 58,9% respectively. The most reliable and predictive thresholds for macrosomia more than 4500g were 105 mm, 78mm and 98 mm respectively for ATD, FL and BPD. In an other study, we have Found that fundal height °> 37 cm is also predictive of such a macrosomia. So we have proposed a pre-diclive score of fetal weight more than 4500 g, based on the best thresholds found for fundal height, ATD, FL and BPD

accouchement du macrosome de 4500 g et plus. A propos de 61 cas

The objective of this study is to review the difficulties in prediction of great macrosomia, to assess trial of labor results, and to confirm the increased risk of perinatal complications. Material and method: in this retrospective study we analyzed 61 deliveries of infants with weights > 4500 g in one year period. This group was compared with a group of infants weighing between 4000 and 4500g [339 cases] born during the same period. Elective cesarean delivery was performed for 3 cases of the second group because of overestimation of fetal weight. 38 cases of the first group [62.3%] were delivered vaginally after underestimation of fetal weight. Incidence of shoulder dystocia in vaginal delivery was 13.5% in the first group and 5.32% in the second one, but difference was not statistically significant [p= 0.07]. difference between incidence of hypoglycemia in the first group [18.03%] and in the second one [2.06%] was highly significant [p=0.00006] there is no reliable method for prediction of fetal weight > than 4500 g. with literature review, we confirm the increased risk of shoulder dystocia, birth asphyxia and hypoglycemia for these infants. So we believe that cesarean delivery is justified in all cases of fetal weight estimation > 4500g