MORBILIDAD FETAL ASOCIADA AL PARTO EN MACROSÓMICOS: ANÁLISIS DE 3981 NACIMIENTOS

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Abstract

Objetivo: Determinar la incidencia de traumatismos asociados al parto y la capacidad, de distintas categorías de peso macrosómico, de predecir una mayor frecuencia de estos traumatismos. Diseño: Estudio retrospectivo. Lugar: Servicio de Maternidad del Hospital Clínico de la Universidad de Chile. Participantes: 3981 nacimientos atendidos desde enero de 2001 a Diciembre de 2003. Resultados evaluados: Tasa de traumatismos asociados al parto. Resultados: La incidencia global de traumatismos asociados al parto fue 0,65%, significativamente más alta en parto vaginal operatorio (1,5%) y vaginal normal (0,7%), en relación a cesáreas (0,2% )(p<0,009). El odds ratio (OR) de traumatismo obstétrico en recién nacidos macrosómicos fue 3,12 (95% CI, 1,34-7,21) y el OR de muerte intraparto en macrosómicos Grado 1 (4000-4499 g) fue 15,6 (95% CI, 1,41-172,37). El OR de parto cesárea, en macrosómicos fue 2,07 (95% CI, 1,69-2,53) y de acuerdo a la categoría de macrosomía, OR 1,9 (95% CI, 1,53-2,36) en Grado 1, OR 4,13 (95% CI, 2,13-7,98) en Grado 2 (4500-4999 g) y OR 5,59 (95% CI, 0,58-53,9) en Grado 3 (³5000 g). Conclusiones: Macrosomía fetal es un importante predictor de parto cesárea y de una mayor morbilidad neonatal y mortalidad fetal intraparto

Translated abstract

Objective: To determine the incidence of morbidity associated with macrosomic delivery, and the ability to predict a higher frequency of morbidity for distinct categories of macrosomia. Study design: We analyzed 3981 births from January 2001 to December 2003, at the Maternity Ward from the University of Chile Clinical Hospital. Afterward, we analyzed the rate of morbidity and mortality associated with route of delivery between different categories of birth weigh. Results: The overall incidence of morbidity associated with delivery was 0.65%, and was significantly higher in operative vaginal delivery (1.5%) and normal vaginal delivery (0.7%) compared to cesareans (0.2%, p<0.009). The odds ratio (OR) for birth trauma in macrosomic newborns was 3.12 (95% CI 1.34-7.21) and the OR of death during delivery in grade 1 macrosomics (4000-4999 g) was 15.6 (95% CI, 1.41-172.37). The OR for cesarean delivery by grade of macrosomia were: Grade 1 (4000-4499 g) 2.07 (95% CI, 1.53-2.36); Grade 2 (4500-4999 g) 4.13 (95% CI, 2.13-7.98); Grade 3 (³5000 g) 5.59 (95% CI, 0.58-53.9). Conclusions: Fetal macrosomia is an important predictor of cesarean delivery and of a higher neonatal morbidity and fetal mortality during delivery

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Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk.

Sheree Boulet, Greg Alexander, Hamisu Salihu … (2003)

We describe maternal risk factors for macrosomia and assess birth weight categories to determine predictive thresholds of adverse outcomes. We analyzed linked live birth and infant death cohort files from 1995 to 1997 for the United States with the use of selected term (37-44 weeks of gestation) single live births to mothers who were US residents. We compared macrosomic infants (4000-4499 g, 4500-4999 g, and >5000 g infants) with a normosomic control group of infants who weighed 3000 to 3999 g. Maternal risk factors for macrosomia included nonsmoking, advanced age, married, diabetes mellitus, hypertension, and previous macrosomic infant or pregnancy loss. The risks of labor complications, birth injuries, and newborn morbidity rose with each gradation of macrosomic birth weight. Infant mortality rates increased significantly among infants weighing >5000 g. Although a definition of macrosomia as >4000 g (grade 1) may be useful for the identification of increased risks of labor and newborn complications, >4500 g (grade 2) may be more predictive of neonatal morbidity, and >5000 g (grade 3) may be a better indicator of infant mortality risk.

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Sonographic estimation of fetal weight. The value of femur length in addition to head and abdomen measurements.

F Hadlock, R Harrist, David Park … (1984)

Sonographic estimation of fetal weight in utero was performed in 167 live-born fetuses examined within one week of delivery. Regression models were based on measurements of abdominal circumference, head circumference, biparietal diameter, and femur length, both alone and in combination. The best results (1 S.D. = 7.5% of actual weight) were obtained by combining measurements of the fetal head, abdomen, and femur, most likely due to the strong linear relationship between femur length and crown-heel length.