ABSTRACT
Predicting PE would enable a better understanding of the physiological mechanisms responsible for this disease. It would also permit the identification of an at-risk population and consequently ease the set up of clinical trials. Over 12,000 articles have been published on this subject. Critical review of the literature reveals that none of the investigations, performed individually, bears sufficient predictive value. However, it appears that the current tendency is to apply a combined approach associating clinical, ultrasonographic and biological factors.
Subject(s)
Pre-Eclampsia/diagnosis , Adult , Biomarkers , Echocardiography , Electrocardiography, Ambulatory , Female , Humans , Pre-Eclampsia/diagnostic imaging , Pre-Eclampsia/physiopathology , Predictive Value of Tests , PregnancyABSTRACT
OBJECTIVE: To develop a nomogram to predict macrosomia with a combination of clinical and ultrasound variables. METHODS: Data from 194 women who underwent sonographic fetal weight estimation were used to develop and calibrate a nomogram to predict fetal macrosomia. The nomogram was subjected to 200 bootstrap resamples for internal validation and to reduce overfit bias. An Internet-based tool was developed to facilitate use of the nomogram. RESULTS: The macrosomia prediction nomogram, based on parity, ethnicity, body mass index and fetal weight estimated macrosomia, had good discrimination and calibration before and after bootstrapping (area under curve (AUC), 0.860 and 0.850, respectively). The predictive accuracy of our nomogram was significantly better than was sonographically estimated fetal weight using Hadlock's formula (AUC, 0.740; P<0.001). We have provided a web-based interface to predict the individual probability of macrosomia. CONCLUSION: We have developed a nomogram to predict the individual probability of macrosomia based on clinical and ultrasound findings. Our web-based interface should help to guide patients and physicians in decision-making.
Subject(s)
Fetal Macrosomia/diagnosis , Adolescent , Adult , Birth Weight , Body Weight , Diagnosis, Computer-Assisted/methods , Female , Fetal Macrosomia/diagnostic imaging , Fetal Macrosomia/ethnology , Fetal Weight , Humans , Models, Statistical , Mothers , Parity , Predictive Value of Tests , Pregnancy , Prenatal Diagnosis/methods , ROC Curve , Sensitivity and Specificity , Ultrasonography, Prenatal/methodsABSTRACT
OBJECTIVE: To determine risk factors of failed labor in case of fetal macrosomia. MATERIALS AND METHODS: Medical charts of two hundred and forty six women who delivered macrosomic infants (>4,000g) between January 2004 and May 2005 were reviewed. Maternal and obstetrical data were analyzed by mode of delivery. Univariate and multivariate (logistic regression analysis) were performed to identify risk factors of failed labor. RESULTS: Rate of cesarean delivery was 18.3%. Indications for cesarean were: failure to progress in 55.6%, arrest in fetal descent in 22.2%, fetal distress in 6.7%, and other in 8.9%. There was a higher risk of failed labor in nulliparous women (p<0.001), in case of a symphysio-fundal measurements>34cm (p=0.004), in nulliparity associated with symphysio-fundal measurements>34cm (p<0.001), in case of previous cesarean delivery (p=0.004), in cases of maternal height<1.65m (p=0.02), and with ocytocin use (p=0.05). In multivariate analysis, nulliparity associated with symphysio-fundal measurements>34cm (OR=5.2; CI 1.5-18.4), previous cesarean section (OR=3.7; CI 1.1-12.4) and maternal height<1.65m (OR=2.6; CI 1.2-5.5) were independent factors of failed labor. CONCLUSION: Failure of labor in case of macrosomia can be predicted in the event of previous cesarean section, shorter maternal height, and association of nulliparity and symphysio-fundal measurements>34cm.
