Acute hypercalcemic crisis: A narrative review with a focus on pregnancy.

A hypercalcemic crisis is a rare therapeutic emergency. However, it should not be overlooked, particularly during pregnancy, as it is associated with significant maternal and fetal morbidity and mortality. The most frequent etiology, including in pregnant women, is primary hyperparathyroidism. Knowledge of calcium-phosphate metabolism during pregnancy is important for understanding and interpreting the clinicopathological abnormalities observed in parathyroid pathology. Despite the expert consensus statement on parathyroid pathology issued by the European Society of Endocrinology, management of hypercalcemic crises remains poorly codified, particularly in pregnant women. Diagnostic examinations and hypocalcemia treatments are generally not recommended during pregnancy; however, it may be necessary to optimize preparation for surgery. Notably, surgery is the treatment of choice, particularly during pregnancy, when it should ideally be performed during the 2nd trimester. Therefore, a multidisciplinary approach is necessary. A consensus among European experts recommends systematic early detection of hypercalcemia during early pregnancy.

Navigating Perinatal Challenges: A Comprehensive Review of Cholestasis of Pregnancy and Its Impact on Maternal and Fetal Health.

Cholestasis of pregnancy (CP), or intrahepatic CP (ICP), represents a condition peculiar to pregnancy, marked by impaired bile acid flow and consequent accumulation in the maternal bloodstream. Primarily emerging in the third trimester, CP is linked with considerable risks to both the mother and fetus, including heightened incidences of preterm birth, fetal distress, and stillbirth, alongside maternal complications such as intense pruritus and liver dysfunction. Despite its clinical significance, the etiology of CP, which involves genetic, hormonal, and environmental factors, remains partially understood. This comprehensive review delves into the physiology and pathophysiology of CP, outlines its clinical manifestations and diagnostic criteria, and discusses the associated maternal and fetal complications. Furthermore, it evaluates current management strategies, prognostic implications, and potential long-term effects on maternal and child health. It also explores future research directions, emphasizing the need for advancements in understanding the pathophysiology of CP, developing novel therapeutic interventions, and improving risk stratification models. By offering a thorough overview of CP, this review aims to enhance clinical awareness, guide management practices, and identify areas requiring further investigation, ultimately contributing to better health outcomes for affected women and their babies.

Investigation and Comparison of Maternal Pre-Pregnancy Body Mass Index Coupled with Gestational Weight Gain on Maternal-Fetal Complications Based on US and Chinese Guidelines: A Retrospective Study.

Compared to Western populations, Chinese and Asians possess distinct genetics, lifestyles, and dietary habits. They tend to have shorter stature, lower Body Mass Index (BMI), and higher body fat percentages than Western populations. The aim of this study was to compare disparities in maternal-fetal outcomes by combining pre-pregnancy BMI and gestational weight gain (GWG) based on distinct US and Chinese guidelines. A total of 2,271 pregnant women who received perinatal care at Fooyin University Hospital from 2016 to 2021 were included. Logistic regression analysis categorized women into twelve groups based on the two criteria to explore the relationships between BMI and GWG, and maternal-fetal outcomes. Among the subjects, only 23.2% and 21.8% women had a normal weight BMI and adequate GWG, based on US and Chinese criteria, respectively. As BMI and GWG increase, the likelihood of developing complications such as gestational diabetes, gestational hypertension or preeclampsia, Cesarean section, and Large for Gestational Age also rises. Conversely, underweight women with excessive GWG exhibited lower risk of preterm birth either by US or Chinese guidelines. Two criteria exhibited similar odds for investigated outcomes, except for gestational hypertension or preeclampsia. Women had more than double the odds of developing gestational hypertension or preeclampsia when using US criteria compared to Chinese criteria. Therefore, it is essential for Asian, especially Chinese women, to be aware of the differences in adverse outcomes such as gestational hypertension or preeclampsia when using US criteria.

Cushing's syndrome during pregnancy - two case reports.

Background: Cushing's syndrome (CS) during pregnancy is a rare endocrine disorder characterized by hypercortisolism, which is significantly associated with maternal-fetal complications. Despite its rarity, CS during pregnancy may be related to a high risk of complications for both the mother and fetus.The aim of the present case study is to update the diagnostic approach to CS during pregnancy and the therapeutic strategies for this medical condition to minimize maternal-fetal complications. Methods: Here, we present two cases of CS in pregnant women, one of whom had twins. Typical clinical symptoms and signs of hypercortisolism developed at the beginning of pregnancy. The plasma cortisol diurnal rhythm of the pregnant patient was absent. CS was confirmed by cortisol and adrenocorticotropic hormone (ACTH) assessment, as well as imaging examination. We investigated the changes in the hypothalamic-pituitary-adrenal axis during normal pregnancy and the etiology, diagnosis and treatment of CS during pregnancy. Conclusion: Due to the associated risks of laparoscopic adrenalectomy,it is uncertain whether this treatment significantly decreases overall maternal mortality. Additional observational research and validation through randomized controlled trials (RCTs) are required. We advise that CS in pregnant women be diagnosed and treated by experienced teams in relevant departments and medical centers.

Determinants of preterm premature rupture of membranes and associated perinatal and maternal outcomes at General Justice Gizenga Mpanza Hospital, South Africa.

Preterm Premature Rupture of Membranes (PPROM) is defined as the rupture of fetal membranes prior to the onset of labor, before 37 weeks gestation and remains a significant obstetric complication of pregnancy with high rates of perinatal morbidity and mortality worldwide. The aim of our study was to establish the determinants of PPROM <34 weeks at this GJG MRH hospital which has a high incidence of PPROM. It was a descriptive , retrospective chart review of women diagnosed with PPROM over a 1 year period from 1st of January 2018 to 31st of December 2018. Detailed clinical and demographic information was recorded. Statistical analysis was carried out using SPSS (Version 28.0 IBM, Armonk, New York, USA) of 7071 singleton deliveries, 428 were diagnosed with PPROM. Majority (69%) were between the age groups of 21 to 30 years. Women belonging to age groups of <20 years and >=30 years, including women who attend antenatal clinics >=4 times were less likely to experience PPROM. History of abortions, previous preterm delivery, previous PPROM and women who had infectious components were determinants of PPROM. Among the neonates delivered by women who had PPROM, 56.3% had an unfavorable outcome.

La rupture prématurée des membranes (PPROM) est définie comme la rupture des membranes fœtales avant le début du travail, avant 37 semaines de gestation et reste une complication obstétricale importante de la grossesse avec des taux élevés de morbidité et de mortalité périnatales dans le monde. Le but de notre étude était d'établir les déterminants de la PPROM <34 semaines dans cet hôpital GJG MRH qui a une incidence élevée de PPROM. Il s'agissait d'un examen descriptif et rétrospectif des dossiers de femmes diagnostiquées avec PPROM sur une période d'un an allant du 1er janvier 2018 au 31 décembre 2018. Des informations cliniques et démographiques détaillées ont été enregistrées. L'analyse statistique a été réalisée à l'aide de SPSS (version 28.0 IBM, Armonk, New York, USA) sur 7 071 accouchements uniques, 428 ont été diagnostiqués avec PPROM. La majorité (69 %) appartenait au groupe d'âge de 21 à 30 ans. Les femmes appartenant aux groupes d'âge <20 ans et >=30 ans, y compris les femmes qui fréquentent les cliniques prénatales >=4 fois, étaient moins susceptibles de souffrir de PPROM. Les antécédents d'avortements, les accouchements prématurés antérieurs, les antécédents de PPROM et les femmes présentant des composantes infectieuses étaient des déterminants de la PPROM. Parmi les nouveau-nés accouchés par des femmes atteintes de PPROM, 56,3 % ont eu une évolution défavorable.

Glycemic variability in diagnosis of gestational diabetes as predictor of pharmacological treatment.

INTRODUCTION: To establish whether glycemic variability (GV) parameters used when gestational diabetes mellitus (GDM) has been diagnosed could help predict the probability that a patient will need pharmacological treatment, and to analyze the link of these parameters to the development of maternal-fetal complications. MATERIALS AND METHODS: A prospective study of 87 women with GDM who underwent retrospective continuous glucose monitoring (CGM) for six days between weeks 26 and 32 of gestation, following diagnosis. The mean glycemia levels and GV variables were analyzed together with their link to maternal-fetal complications, and the need for pharmacological treatment. ROC (receiver operating characteristic) curves were developed to determine validity to detect the need for pharmacological treatment. RESULTS: Patients with higher mean glycemia (p < 0.001) and continuous overlapping of net glycemic action in a period of n-hours (CONGAn) (p = 0.001) required pharmacological treatment. The ROC curves showed cut-off points of 98.81 mg/dL for mean glycemia, and 86.70 mg/dL for CONGAn, with 83.3% sensitivity and 67.8% specificity for both parameters. No relation between the GV parameters and development of maternal-fetal complications was observed. CONCLUSIONS: The use of CGM, once GDM is diagnosed, enables us to identify those patients who would benefit from closer monitoring during gestation, and facilitate a speedier take-up of pharmacological treatment. However, prospective studies involving a higher number of patients are needed, as well as a cost assessment for recommending the use of CGM following GDM diagnosis.

Outcomes of liver diseases in pregnant females: A study from a tertiary care medical center in Pakistan.

Objective: To determine the etiologies and outcomes of liver disease in pregnancy in a developing country. Method: A total of 336 consecutive pregnant women with liver disease were included in this prospective cohort study conducted at the Department of Gastroenterology, Jinnah Postgraduate Medical Center, Karachi from August 2019 to August 2021. Patients' baseline demographic, clinical, and laboratory data and outcomes were collected on a pre-designed questionnaire. Results: Among all the pregnant females, the most common liver disease was acute hepatitis E virus (HEV) infection (37.2%), followed by preeclampsia (PEC)/eclampsia (EC), hemolysis, elevated liver enzymes & low platelets (HELLP) syndrome, and hyperemesis gravidarum (HG). The most common maternal complications were fulminant hepatic failure (FHF) in 14.9% and placental abruption in 11.0%. Fetal complications included intrauterine death (IUD) in 20.8% and preterm birth in 8.6%. The maternal and neonatal mortality rates were 11.6% and 39.6%, respectively. Among the predictors, low maternal weight, low body mass index (BMI), and low hemoglobin (Hb) were associated with increased maternal mortality. Low fetal weight, height, maternal systolic blood pressure (SBP), and low maternal Hb were independent predictors of fetal mortality. Conclusion: In our cohort of pregnant females in a tertiary care medical center, acute HEV was the most common liver disease, followed by PEC/EC, HELLP, and HG. Maternal and fetal deaths were alarming in this group of patients and demanded careful management.

Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes.

BACKGROUND: (1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.

ASSESSMENT OF NEONATAL AND MATERNAL COMPLICATIONS IN PREGNANT WOMEN WITH GESTATIONAL DIABETES IN THE IRANIAN POPULATION.

Context: Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. It is also a growing problem worldwide and is associated with many maternal and fetal complications during and after pregnancy. Objective: This study aimed to investigate the neonatal and maternal complications of gestational diabetes in the Iranian population of pregnant women. Design: This prospective cohort study was carried out on the health assessment data of pregnant women in the age range of 18-45 years who were referred to health centers affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from March 2019 to September 2020. Subjects and Methods: Overall, 2,500 pregnant women with GDM and 7,700 healthy pregnant women were enrolled in the GDM and healthy groups, respectively. Individuals' data were recorded in an electronic health record system (SINA System) and were later collected and analyzed. Results: Significant between-group differences were observed in terms of cesarean delivery risk, hypertension, fetal macrosomia, preeclampsia, preterm birth, fetal birth weight, and neonatal icterus in GDM and non-GDM groups. However, no significant differences were found in terms of stillbirth, and low birth weight between the two groups. Based on the logistic regression model, GDM significantly increased the risk of cesarean delivery, fetal macrosomia, and neonatal icterus. Conclusions: The fetal macrosomia leading to the cesarean delivery, and neonatal icterus were determined as the significant complications of GDM in the Iranian population. These results can provide valuable insight into healthcare planning.

[Perinatal outcome of closely spaced pregnancies: a Moroccan retrospective study]. / Devenir périnatal issu des grossesses rapprochées: étude rétrospective marocaine.

Introduction: the purpose of this study is to provide Moroccan data, study maternal risk factors and identify perinatal complications related to closely-spaced pregnancies. Methods: we conducted a retrospective case-control study at the Provincial Hospital Center in the city of Settat from June 1, 2020 to June 1, 2021. A total of 670 patients were admitted, but only 630 were included in the study. They were divided into 2 groups: a group of patients whose interpregnancy interval was <9 months (N = 443) and a control group whose interpregnancy interval was >9 months (N = 187). Results: prematurity, hypotrophy and anemia p<0.05 were the main complications, the main risk factors for closely-spaced pregnancies were age >35 years (OR =19.079 (4.98; 73.06) p < 0.005), coming from a rural area (OR = 0.468 [0.28; 0.78] p < 0.005), having a low socioeconomic status (OR =3.465 [2.06; 5.81]; p < 0.005); the absence of contraceptive prescription in the postpartum period (OR =15.77 [7.31; 33.99]; p < 0.005); and breastfeeding breaks before getting pregnant (OR = 49.462 [15.78; 155.03]; p<0.05). Conclusion: prevention and specific family planning methods are necessary to avoid perinatal complications.

Prevalence and Complications of Subclinical and Overt Hypothyroidism in Pregnancy at North Indian Tertiary Care Center.

Background: Thyroid disorders are one of the commonest endocrine problems among pregnant women. It is often argued that it is not only overt, but subclinical thyroid dysfunction also has similar adverse effects on maternal and fetal outcomes. There is a huge deficiency of data from the Indian population to assess the prevalence of thyroid dysfunction in pregnancy. This study aimed to determine the prevalence of thyroid disorders in pregnancy and their impact on obstetrical outcomes in the Indian population. The study also had the objective of finding a correlation between maternal and fetal thyroid-stimulating hormone (TSH) levels in hypothyroid pregnancies. Materials and Methods: Around 1055 pregnant women in the first and second trimesters were enrolled in the study. A detailed history was noted and general examinations were done. Apart from routine obstetrical investigations, TSH level estimation was done. If the TSH level was deranged, then free T4 (fT4) and free T3 (fT3) levels were also estimated. Furthermore, 50 hypothyroid and euthyroid pregnant women from the same cohort were followed till delivery. Their obstetrical and perinatal outcomes were noted. Results: The prevalence of thyroid dysfunction was 36.5% in this study, which was quite high in the population. Moreover, hypothyroid groups were prone to have pregnancy-induced hypertension (P = 0.03), intrauterine growth restriction (P = 0.05), and preterm delivery (P = 0.04) as compared to control. Cesarean section rate for fetal distress was significantly higher among pregnant hypothyroid women (P = 0.05). Neonatal respiratory distress and low appearance, pulse, grimace, activity, and respiration (APGAR) () scores were significantly more in the hyperthyroidism group (P = 0.04 and P = 0.02, respectively). Maternal TSH was significantly correlated with hemoglobin levels, HbA1c, and systolic blood pressure. Conclusions: Significant adverse effects on maternal and fetal outcomes were seen emphasizing the importance of routine antenatal thyroid screening.

Glomerular diseases in pregnancy: pragmatic recommendations for clinical management.

Our understanding of the various aspects of pregnancy in women with kidney diseases has significantly improved in the last decades. Nevertheless, little is known about specific kidney diseases. Glomerular diseases are not only a frequent cause of chronic kidney disease in young women, but combine many challenges in pregnancy: immunologic diseases, hypertension, proteinuria, and kidney tissue damage. An international working group undertook the review of available current literature and elicited expert opinions on glomerular diseases in pregnancy with the aim to provide pragmatic information for nephrologists according to the present state-of-the-art knowledge. This work also highlights areas of clinical uncertainty and emphasizes the need for further collaborative studies to improve maternal and fetal health.

Prenatal ultrasound evaluation of fetal cutaneous hemangioma and related complications.

OBJECTIVES: Congenital hemangiomas are rare benign vascular tumors but can lead to serious adverse pregnancy outcomes. Its prenatal diagnosis is a challenge. We explored the clinical applications of prenatal ultrasound for evaluating fetal cutaneous hemangioma and associated complications. METHODS: A retrospective observational study was conducted comprising a population of pregnant women with fetal cutaneous hemangioma, the latter diagnosed by prenatal ultrasound, between January 2016 and December 2020. The clinical characteristics, sonographic images, complications, and pregnancy outcomes were documented and analyzed. RESULTS: We identified 20 cases of fetal cutaneous hemangioma diagnosed by prenatal ultrasound and confirmed by postpartum examinations. Most hemangiomas were in the head and neck (55%), with either solid isoechoicity (25%) or solid mildly hyperechoic (25%), and well-circumscribed (80%) mass. Eight (40%) fetuses experienced complications, which often occurred in fetuses with large hemangiomas (67% with maximum diameter ≥5 cm; 100% with a volume ≥40 cm3). The most common complications were cardiac-related (88%), including elevated cardiothoracic area ratio, atrioventricular valve regurgitation, and fetal hydrops. A large hemangioma was usually associated with advanced gestational age and a fast hemangioma growth rate. In five (25%) cases, the pregnancy was terminated; these involved hemangioma of the head or neck. One newborn developed Kasabach-Merritt phenomenon, pulmonary hemorrhage and respiratory distress, and died 3 days after birth. Among the 14 (70%) fetuses that survived birth, all hemangiomas disappeared or regressed after treatments with propranolol, interventional surgery, or observed routinely. CONCLUSIONS: Prenatal ultrasound examination can accurately diagnose fetal cutaneous hemangioma and related complications to facilitate appropriate management during the pregnancy. RATIONALE: Prenatal diagnosis of cutaneous hemangiomas is a clinical challenge. Prenatal ultrasound examination could be a method to accurately diagnose and monitor these hemangiomas.

Procedimiento clínico-quirúrgico en una paciente embarazada con una derivación urológica compleja. Reporte de un caso / Clinical-surgical approach in a pregnant patient with complex urological diversion. A case report

Resumen ANTECEDENTES: El mielomeningocele es el defecto del tubo neural más frecuente; se registra un caso por cada 1000 nacidos vivos. Es más frecuente en mujeres, que resultan con secuelas discapacitantes, entre ellas las urológicas. Pueden subsanarse con diferentes técnicas quirúrgicas y derivaciones urológicas complejas que las predispone a infecciones de vías urinarias de repetición y, cuando hay embarazo, complicaciones materno-fetales y dificultad para el acceso quirúrgico, en caso de cesárea. CASO CLÍNICO: Paciente con 14 semanas de embarazo, 27 años de edad, con diagnóstico de mielomeningocele y vesicoplastia, con múltiples infecciones urinarias y ruptura de membranas pretérmino. Finalización del embarazo por cesárea a las 33 semanas, por indicación de las condiciones fetales. La técnica de la cesárea se modificó para no dañar la cistoplastia y evitar complicaciones con las adherencias en la pelvis. CONCLUSIONES: El mejor pronóstico materno-fetal en pacientes con derivación urológica compleja se consigue con la búsqueda intencionada de infecciones urinarias y tratamiento oportuno y adecuado, además de una planificación multidisciplinaria al momento de la finalización del embarazo.

Abstract BACKGROUND: Myelomeningocele is the most common neural tube defect; one case per 1000 live births is reported. It is more frequent in females, resulting in disabling sequelae, including urological sequelae. They can be corrected with different surgical techniques and complex urological derivations that predispose them to repeated urinary tract infections and, when there is pregnancy, maternal-fetal complications and difficulty for surgical access, in case of cesarean section. CLINICAL CASE: Patient 14 weeks pregnant, 27 years old, diagnosed with myelomeningocele and vesicoplasty, with multiple urinary tract infections and preterm rupture of membranes. Termination of pregnancy by cesarean section at 33 weeks, due to fetal conditions. The cesarean section technique was modified so as not to damage the cystoplasty and to avoid complications with adhesions in the pelvis. CONCLUSIONS: The best maternal-fetal prognosis in patients with complex urologic diversion is achieved with the intentional search for urinary tract infections and timely and adequate treatment, in addition to multidisciplinary planning at the time of termination of pregnancy.

A Rare and Challenging Case of Refractory Fetal Supraventricular Tachycardia.

Fetal supraventricular tachycardia can be difficult to manage and offers a challenging treatment course, particularly in refractory cases. The treatment course must balance maternal well-being with the health status of the fetus, all while racing against possible progression to hydrops fetalis or permanent cardiac dysfunction. We describe a case of fetal supraventricular tachycardia that demonstrates many of these concepts, as well as the importance of utilizing several treatment pathways in refractory cases.

Complications Associated with Fetal Cardiac Interventions: Prevalence and Management - Experience from 213 Procedures.

INTRODUCTION: Fetal cardiac interventions (FCIs) were introduced to change the natural history of some congenital heart defects. The aim of this study was to analyze the complications and management strategies associated with FCI at our institution. METHODS: The local FCI database was retrospectively reviewed for all fetuses who underwent FCI in our center since 2000 regarding complications and fetal outcome. RESULTS: 213 FCIs have been performed in 165 fetuses since October 2000: 60 with fetal pulmonary valvuloplasty, 4 with atrial septostomy, 7 with atrial septal stents, and 142 with fetal aortic valvuloplasty (FAV). The median gestational age at intervention was 27+1/7 weeks (21+4/7-38+3/7) for all interventions. The most common complications needing treatment were bradycardia (37%) and pericardial effusions (12%). FAV procedure-related mortality was significantly lower in the recent period since 2014 (14% early vs. 4% recent era, p = 0.03) due to a learning curve and improved management strategies. There were no relevant maternal complications. Premature deliveries occurred in 22.8% percent of all patients. CONCLUSIONS: Complications during FCI were frequent and must be expected. Strategies to reduce their prevalence as well as timely and correct treatment are mandatory to keep mortality rates low.

Weight gain during pregnancy: A narrative review on the recent evidences.

Gestational weight gain is necessary for the normal fetus development, in fact a series of studies have evidenced that both low and excessive gestational weight gain is associated with negative fetal-neonatal outcomes. So, evidences on the optimal gestational weight gain across the ranges of the pre-pregnancy maternal body mass index are necessary. In this context, while for normal weight and underweight the recommendations of IOM are clearly stated and supported by well designed and conducted clinical studies, those for the obese pregnant women are even today debated. Pre-pregnancy obesity is associated with high risk to develop hypertension, gestational diabetes, cesarean section and high birth weight. The Institute of Medicine guidelines, in 2009, recommended that women with obesity gain 11-20 lb at a rate of 0.5 lb/week during the second and third trimesters of pregnancy. Successively, taking into account a series of meta-analysis, the American College of Obstetricians and Gynecologists emphasized that the IOM weight gain targets for obese pregnant women are too high. However the high risk to have babies small for gestational age, related to a low weight gain or a losing of weight during pregnancy, has also been demonstrated. More recent studies have taken into consideration the maternal and fetal outcomes of obese pregnant women with different obesity class (I,II,III) and different weight gain during pregnancy. The analysis of these studies, discussed in this narrative review, show that the appropriate gestational weight gain should be personalized considering the three obesity class; furthermore both an upper and lower limit of gestational weight gain should be reconsidered in order to prevent the negative maternal and fetal outcomes in these women.

Cholestatic Liver Disease and Pregnancy: A Systematic Review and Meta-Analysis.

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are two types of chronic cholestatic liver disease (CCLD). Little is known regarding the relationship between these conditions and pregnancy. We performed a systematic review and meta-analysis regarding the maternal and fetal outcomes amongst patients with a known diagnosis of PBC and PSC undergoing pregnancy. Our analysis shows that patients with PBC and PSC who undergo pregnancy are at an increased risk of pre-term delivery, as well as the development of new or worsening pruritus during pregnancy. Additionally, patients with PBC are at higher risk of undergoing a biochemical disease flare during the postpartum period compared to during pregnancy. However, there were no documented cases of maternal mortality or development of decompensated cirrhosis during pregnancy or the postpartum period.

A retrospective identification of risk factors associated with fetal macrosomia.

Despite extensive work on macrosomia, it is impossible to predict women at risk. Current prediction strategies which include clinical examination and ultrasound are imprecise. This study aims to determine the risk factors associated with macrosomia. It was a descriptive, retrospective chart review of women delivered of macrosomic neonates over a two-year period from 2015-2016. Detailed clinical and demographic information was recorded. Statistical analysis was carried out using SPSS (version 25.0 IBM, Armonk, New York, USA). Of 22 244 singleton deliveries, 415 were macrosomic infants (1.9%). The mean birth weight for macrosomic infants was 4.39 ± 0.43 (range 4-5.15) kg and males were more in number and weight. Macrosomic infants occurred more in age groups 25-29 years and peaked with BMI ≥30 kg/m2. Majority were cesarean sections compared to vaginal deliveries (56.6% vs 43.4%; p=0.006) respectively. Vaginal delivery of macrosomic infants was associated with complications. Significant differences were found between fetal macrosomia and clinical characteristics such as body mass index, parity, advanced maternal age, and male fetal sex. Hypoglycaemia was most frequent in infants born to non-diabetic mothers (98.1%). Antenatal risk factors are important in the prediction of macrosomia, but fetal and maternal outcome depends on labour management.

A retrospective identification of risk factors associated with fetal macrosomia

Despite extensive work on macrosomia, it is impossible to predict women at risk. Current prediction strategies which include clinical examination and ultrasound are imprecise. This study aims to determine the risk factors associated with macrosomia. It was a descriptive, retrospective chart review of women delivered of macrosomic neonates over a two-year period from 2015-2016. Detailed clinical and demographic information was recorded. Statistical analysis was carried out using SPSS (version 25.0 IBM, Armonk, New York, USA). Of 22 244 singleton deliveries, 415 were macrosomic infants (1.9%). The mean birth weight for macrosomic infants was 4.39 ± 0.43 (range 4-5.15) kg and males were more in number and weight. Macrosomic infants occurred more in age groups 25-29 years and peaked with BMI ≥30 kg/m2 . Majority were cesarean sections compared to vaginal deliveries (56.6% vs 43.4%; p=0.006) respectively. Vaginal delivery of macrosomic infants was associated with complications. Significant differences were found between fetal macrosomia and clinical characteristics such as body mass index, parity, advanced maternal age, and male fetal sex. Hypoglycaemia was most frequent in infants born to non-diabetic mothers (98.1%). Antenatal risk factors are important in the prediction of macrosomia, but fetal and maternal outcome depends on labour management. (Afr J Reprod Health 2022; 26[7]: 127-134).