Antepartum detection of macrosomic fetus: the effect of misdiagnosis

To determine the effect of misdiagnosis of macrosomia on maternal and perinatal outcomes. We conducted a retrospective study, between January 2007 and December 2008 of women [n = 464] who delivered singleton neonates with actual birth weight over 4000g and in whom fetal weight was estimated, by both methods :sonographic and clinical, up to 3 days before delivery. Statistical comparisons were made between patients in whom fetal macrosomia was predicted: "prediction " group [n=336]and those in whom it was not " non prediction "group [n=128] for outcome variables. The cesarean delivery was performed in 35.9% in " non predicted " group, and in 35.7% in the " predicted " group. The difference was not statistically significant. Failure to detect macrosomia was associated with higher rates of maternal and fetal complications in the group " non predicted " compared with the group " predicted " :perineal trauma, post partum hemorrhage, 5- minute Apgar scores less than 7, and shoulder dystocia, mostly related to the higher rate of surgical vaginal deliveries. The misdiagnosis of fetal macrosomia substantially did not modify the cesarean section rate but leads to increase the maternal and neonatal complications

Percutaneous closure of using Occlusion DeviceOstium Secundum Septal defect amplatzer occlusion device: Experience of cardiology department, Hedi Chaker Hospital, Sfax, Tunisia

To report our clinical experience with transcatheter closure of ostium secundum atrial septal defects [OS ASDs] using Amplatzer septal occluder. It's a retrospective study conducted between October 2005 and April 2010 and involving 34 patients. The procedures were conducted in the hemodynamic laboratory under general anesthesia with transthoracic [TTE] and transoesophageal echocardiographic [TEE] monitoring. Clinical and echocardiography assessments of the patients were conducted within 24 hours post procedure and several months after the procedure. From the 34 patients, 28 [82%] were females. The middle age was 27.5 years. The mean ASD diameter was 19.4 mm by TTE; 18.1 mm [12-38] by TEE, and 23.4 by angiography. The average size of the implanted devices was 23.2 mm ranging from 10 to 34 mm. The final success rate of the procedure was 90.9% [30/33]. One patient was excluded from transcatheter occlusion and three patients [8,6%] had complications including two prosthesis migrations and one large residual shunting. A total of 4 patients [11.7%] underwent surgery. No major complication [thromboembolic events, obstruction of intracardiac structures, cardiac perforation, device embolization and endocarditis] or death has occurred during follow-up and all devices were securely anchored without any persistent residual shunts. Compared to previous data of the literature, percutaneous closure of OS ASDs using Amplatzer device appears safe and effective according to our experience of the cardiology department of Hedi Chaker Hospital