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1.
PLoS Med ; 21(7): e1004420, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38976676

RESUMO

BACKGROUND: The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes. METHODS AND FINDINGS: A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations. CONCLUSIONS: In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term. TRIAL REGISTRATION: The trial is registered with ISRCTN (41918550).


Assuntos
Diabetes Gestacional , Humanos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Feminino , Gravidez , Suécia/epidemiologia , Adulto , Resultado da Gravidez/epidemiologia , Fatores de Risco , Análise por Conglomerados , Teste de Tolerância a Glucose , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/diagnóstico , Organização Mundial da Saúde , Recém-Nascido
2.
J Perinat Med ; 52(6): 623-632, 2024 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-38860644

RESUMO

OBJECTIVES: To report the diagnostic accuracy of ultrasound in identifying fetuses with macrosomia in pregnancies complicated by gestational or pregestational diabetes. METHODS: Medline, Embase and Cochrane databases were searched. Inclusion criteria were singleton pregnancies complicated by diabetes undergoing third-trimester ultrasound evaluation. The index test was represented by ultrasound estimation of fetal macrosomia (estimated fetal weight EFW or abdominal circumference AC >90th or 95th percentile). Subgroup analyses were also performed. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio were computed using the hierarchical summary receiver-operating characteristics model. RESULTS: Twenty studies were included in the systematic review including 8,530 pregnancies complicated by diabetes. Ultrasound showed an overall moderate accuracy in identifying fetuses with macrosomia with a sensitivity of 71.2 % (95 % CI 63.1-78.2), a specificity of 88.6 % (95 % CI 83.9-92.0). The interval between ultrasound and birth of two weeks showed the highest sensitivity and specificity (71.6 %, 95 % CI 47.9-87.3 and 91.7, 95 % CI 86.2-95.5). EFW sensitivity and specificity were 76.6 % (95 % CI 70.1-82.3) and 82.9 % (95 % CI 80.9-84.8), while AC 84.8 % (95 % CI 78.2-90.0) and 73.7 % (95 % CI 71.0-76.4). CONCLUSIONS: Ultrasound demonstrates an overall good diagnostic accuracy in detecting fetal macrosomia in pregnancies with diabetes.


Assuntos
Diabetes Gestacional , Macrossomia Fetal , Gravidez em Diabéticas , Ultrassonografia Pré-Natal , Humanos , Macrossomia Fetal/diagnóstico por imagem , Macrossomia Fetal/diagnóstico , Gravidez , Feminino , Ultrassonografia Pré-Natal/métodos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/diagnóstico por imagem , Gravidez em Diabéticas/diagnóstico por imagem , Sensibilidade e Especificidade
4.
Obstet Gynecol Surv ; 79(4): 233-241, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38640129

RESUMO

Importance: Macrosomia represents the most significant risk factor of shoulder dystocia (SD), which is a severe and emergent complication of vaginal delivery. They are both associated with adverse pregnancy outcomes. Objective: The aim of this study was to review and compare the most recently published influential guidelines on the diagnosis and management of fetal macrosomia and SD. Evidence Acquisition: A comparative review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists, the National Institute for Health and Care Excellence, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and the Department for Health and Wellbeing of the Government of South Australia on macrosomia and SD was conducted. Results: The ACOG and RANZCOG agree that macrosomia should be defined as birthweight above 4000-4500 g regardless of the gestational age, whereas the National Institute for Health and Care Excellence defines macrosomia as an estimated fetal weight above the 95th percentile. According to ACOG and RANZCOG, ultrasound scans and clinical estimates can be used to rule out fetal macrosomia, although lacking accuracy. Routine induction of labor before 39 weeks of gestation with the sole indication of suspected fetal macrosomia is unanimously not recommended, but an individualized counseling should be provided. Exercise, appropriate diet, and prepregnancy bariatric surgery are mentioned as preventive measures. There is also consensus among the reviewed guidelines regarding the definition and the diagnosis of SD, with the "turtle sign" being the most common sign for its recognition as well as the poor predictability of the reported risk factors. Moreover, there is an overall agreement on the algorithm of SD management with McRoberts technique suggested as first-line maneuver. In addition, appropriate staff training, thorough documentation, and time keeping are crucial aspects of SD management according to all medical societies. Elective delivery for the prevention of SD is discouraged by all the reviewed guidelines. Conclusions: Macrosomia is associated not only with SD but also with maternal and neonatal complications. Similarly, SD can lead to permanent neurologic sequalae, as well as perinatal death if managed in a suboptimal way. Therefore, it is crucial to develop consistent international practice protocols for their prompt diagnosis and effective management in order to safely guide clinical practice and improve pregnancy outcomes.


Assuntos
Distocia , Distocia do Ombro , Gravidez , Feminino , Recém-Nascido , Humanos , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/prevenção & controle , Distocia/terapia , Distocia/prevenção & controle , Distocia do Ombro/diagnóstico , Distocia do Ombro/etiologia , Distocia do Ombro/terapia , Austrália , Parto Obstétrico/métodos
5.
Am J Obstet Gynecol MFM ; 6(5): 101346, 2024 05.
Artigo em Inglês | MEDLINE | ID: mdl-38479488

RESUMO

OBJECTIVE: This was a systematic review and meta-analysis comparing maternal and neonatal outcomes of patients screened with the 1-step or 2-step screening method for gestational diabetes mellitus. DATA SOURCES: PubMed, Scopus, Cochrane, ClinicalTrials.gov, and LILACS were searched from inception up to September 2022. STUDY ELIGIBILITY CRITERIA: Only randomized controlled trials were included. Studies that had overlapping populations were excluded (International Prospective Register of Systematic Review registration number: CRD42022358903). METHODS: Risk ratios were computed with 95% confidence intervals by 2 authors. Unpublished data were requested. Large for gestational age was the primary outcome. RESULTS: The search yielded 394 citations. Moreover, 7 randomized controlled trials met the inclusion criteria. A total of 54,650 participants were screened for gestational diabetes mellitus by either the 1-step screening method (n=27,163) or the 2-step screening method (n=27,487). For large for gestational age, there was no significant difference found between the groups (risk ratio, 0.99; 95% confidence interval, 0.93-1.05; I2=0%). Newborns of patients who underwent 1-step screening had higher rates of neonatal hypoglycemia (risk ratio, 1.24; 95% confidence interval, 1.14-1.34; I2=0%) and neonatal intensive care unit admissions (risk ratio, 1.13; 95% confidence interval, 1.04-1.21; I2=0%) than newborns of patients who underwent 2-step screening. Patients in the 1-step screening method group were more likely to be diagnosed with gestational diabetes mellitus (risk ratio, 1.73; 95% confidence interval, 1.44-2.09; I2=80%) than patients in the 2-step screening method group. In addition, among trials that tested all patients before randomization and excluded patients with pregestational diabetes mellitus, newborns were more likely to have macrosomia (risk ratio, 1.27; 95% confidence interval, 1.21-1.34; I2=0%). Overall risk of bias assessment was of low concern. CONCLUSION: Large for gestational age did not differ between patients screened using the 1-step screening method and those screened using the 2-step screening method. However, patients randomized to the 1-step screening method had higher rates of neonatal hypoglycemia and neonatal intensive care unit admission and maternal gestational diabetes mellitus diagnosis than the patients randomized to the 2-step screening method.


Assuntos
Diabetes Gestacional , Resultado da Gravidez , Humanos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Gravidez , Feminino , Recém-Nascido , Resultado da Gravidez/epidemiologia , Programas de Rastreamento/métodos , Macrossomia Fetal/epidemiologia , Macrossomia Fetal/diagnóstico , Hipoglicemia/diagnóstico , Hipoglicemia/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
7.
BMJ Open Diabetes Res Care ; 11(6)2023 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-38164706

RESUMO

INTRODUCTION: We evaluate which screening and diagnostic approach resulted in the greatest reduction in adverse pregnancy outcomes due to increased treatment. RESEARCH DESIGN AND METHODS: This study presents a secondary analysis of a randomized community non-inferiority trial conducted among pregnant women participating in the GULF Study in Iran. A total of 35 430 pregnant women were randomly assigned to one of the five prespecified gestational diabetes mellitus (GDM) screening protocols. The screening methods included fasting plasma glucose (FPG) in the first trimester and either a one-step or a two-step screening method in the second trimester of pregnancy. According to the results, participants were classified into 6 groups (1) First-trimester FPG: 100-126 mg/dL, GDM diagnosed at first trimester; (2) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at first trimester; (3) First trimester FPG: 92-99.9 mg/dL, GDM diagnosed at second trimester; (4) First trimester FPG: 92-99.9 mg/dL, healthy at second trimester; (5) First trimester FPG<92 mg/dL, GDM diagnosed at second trimester; (6) First trimester FPG<92 mg/dL, healthy at second trimester. For our analysis, we initially used group 6, as the reference and repeated the analysis using group 2, as the reference group. The main outcome of the study was major adverse maternal and neonatal outcomes. RESULTS: Macrosomia and primary caesarean section occurred in 9.8% and 21.0% in group 1, 7.8% and 19.8% in group 2, 5.4% and 18.6% in group 3, 6.6% and 21.5% in group 4, 8.3% and 24.0% in group 5, and 5.4% and 20.0% in group 6, respectively. Compared with group 6 as the reference, there was a significant increase in the adjusted risk of neonatal intensive care unit (NICU) admission in groups 1, 3, and 5 and an increased risk of macrosomia in groups 1, 2, and 5. Compared with group 2 as the reference, there was a significant decrease in the adjusted risk of macrosomia in group 3, a decreased risk of NICU admission in group 6, and an increased risk of hyperglycemia in group 3. CONCLUSIONS: We conclude that screening approaches for GDM reduced the risk of adverse pregnancy outcomes to the same or near the same risk level of healthy pregnant women, except for the risk of NICU admission that increased significantly in groups diagnosed with GDM compared with healthy pregnant women. Individuals with slight increase in FPG (92-100 mg/dL) at first trimester, who were diagnosed as GDM, had an even increased risk of macrosomia in comparison to those group of women with FPG 92-100 mg/dL in the first trimester, who were not diagnosed with GDM, and developed GDM in second trimester TRIAL REGISTRATION: IRCT138707081281N1 (registered: February 15, 2017).


Assuntos
Diabetes Gestacional , Feminino , Humanos , Recém-Nascido , Gravidez , Cesárea , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/epidemiologia , Teste de Tolerância a Glucose , Resultado da Gravidez/epidemiologia , Aumento de Peso
8.
Arch. endocrinol. metab. (Online) ; 60(1): 36-41, Feb. 2016. tab, graf
Artigo em Inglês | LILACS | ID: lil-774626

RESUMO

ABSTRACT Objective Our goal was to investigate which glucose measurement from the 75-g oral glucose tolerance test (OGTT) has more capability of predicting large for-gestational-age (LGA) newborns of mothers with gestational diabetes mellitus (GDM). Subjects and methods The study group consisted of 118 consecutively pregnant women with singleton pregnancy, patients of Outpatients Department of the Endocrinology, Diabetes, and Metabolic Disorders Clinic. All were prospectively screened for GDM between 24th and 28th week of pregnancy and followed to delivery. Outcome measures included: patients’ ages, pre-pregnancy BMI, BMI before delivery, FPG, 1 and 2 hour OGTT glucose values, haemoglobin A1c at third trimester, gestational week of delivery, mode of delivery and baby birth weight. Results From 118 pregnancies, 78 (66.1%) women were with GDM, and 40 (33.9%) without GDM. There were statistically significant differences (30.7 versus 5.0%, p < 0.01) between LGA newborns from GDM and control group, respectively. Gestation week of delivery and fasting glucose levels were independent predictors for LGA (Beta = 0.58 and Beta = 0.37 respectively, p < 0.01). Areas under the receiver operator characteristic curve (AUC) were compared for the prediction of LGA (0.782 (0.685-0.861) for fasting, 0.719 (0.607-0.815) for 1-hour and 0.51 (0.392-0.626) for 2-hour OGTT plasma glucose levels). Conclusion Fasting and 1-hour plasma glucose levels from OGTT may predict LGA babies in GDM pregnancies.


Assuntos
Adulto , Feminino , Humanos , Recém-Nascido , Gravidez , Glicemia/análise , Diabetes Gestacional/metabolismo , Macrossomia Fetal/diagnóstico , Idade Gestacional , Teste de Tolerância a Glucose/métodos , Peso ao Nascer , Índice de Massa Corporal , Tamanho Corporal/fisiologia , Diabetes Gestacional/diagnóstico , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Curva ROC
9.
Arch. argent. pediatr ; 113(5): e290-e293, oct. 2015. tab, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: lil-757074

RESUMO

Reportamos un neonato masculino con defectos de línea media, cardiopatía congénita y polidactilia, características sugestivas de trisomía 13. Sin embargo, el reporte de cariotipo fue normal. Por hallazgos clínicos, el diagnóstico final probable fue pseudotrisomía 13. Aunque el pronóstico de ambas condiciones es pobre, los estudios genéticos siempre son necesarios para establecer una adecuada asesoría genética. Si bien hay síndromes con presentación similar, como el de Meckel, el de Smith-Lemli- Opitz, el de Pallister-Hall y el hidroletalus, se puede realizar una aproximación diagnóstica basada en los antecedentes perinatales, el peso al nacer, el tiempo de supervivencia y algunos rasgos característicos de cada síndrome. Además, pueden existir, en algunos países, limitaciones para realizar estudios genéticos, por lo que los criterios clínicos pueden ser relevantes.


We report a male infant with midline defects, congenital heart disease and polydactyly, features suggestive of trisomy 13. However, the report of the karyotype was normal. By clinical findings the final diagnosis was likely to be Pseudotrisomy 13. Although the prognosis is poor in both conditions, the genetic study is always necessary to establish an adequate genetic counseling. Although there are syndromes with similar presentation as Meckel syndrome, Smith-Lemli-Opitz syndrome, Pallister-Hall syndrome and hydrolethalus, it is possible to make a diagnostic approach based on the perinatal history, birth weight, survival time, and some characteristics of each syndrome. However, limitations may exist to perform genetic studies in some countries, therefore the clinical criteria may be relevant.


Assuntos
Humanos , Masculino , Recém-Nascido , Trissomia/diagnóstico , Cromossomos Humanos Par 13 , Macrossomia Fetal/diagnóstico , Deformidades Congênitas da Mão/diagnóstico , Holoprosencefalia/diagnóstico , Fenda Labial/diagnóstico , Fissura Palatina/diagnóstico , Polidactilia/diagnóstico
10.
Lima; s.n; 2014. 33 p. tab.
Tese em Espanhol | LILACS, LIPECS | ID: lil-758215

RESUMO

Este estudio se realizó para evaluar el valor predictivo del ultrasonido en el diagnóstico de macrosomia fetal, en gestantes entre las 37 y 41 semanas. Métodos: El estudio consistió en contrastar los datos obtenidos de las estimaciones ecográficas de fetos con los pesos de los recién nacidos. De la base de datos de gestantes evaluadas en la "unidad de medicina fetal", seleccionamos las mujeres con embarazos únicos, entre las 37 y 41 semanas, que tenían macrosomía y las que no tenían macrosomía por ultrasonido. Al final del embarazo por parto vaginal o cesárea, comparamos nuestras estimaciones con el peso del recién nacido (macrosómico o no). Se calcularon el valor predictivo, la sensibilidad y especificidad de la ultrasonografía. Resultados: Un total de 840 pacientes participaron en este estudio. el valor predictivo positivo del ultrasonido para predecir el peso al nacer de 4000g o más fue de 71 por ciento, con una sensibilidad del 77 por ciento y una especificidad del 94 por ciento. Conclusión: La estimación del ponderado fetal de macrosomía por ultrasonido en gestantes a término en la Unidad de Medicina Fetal está acorde a los valores referenciales a nivel internacional, pero tienen poca sensibilidad para detectar macrosomia en fetos...


Assuntos
Humanos , Adolescente , Adulto , Feminino , Gravidez , Adulto Jovem , Macrossomia Fetal/diagnóstico , Monitorização Fetal , Ultrassonografia Pré-Natal , Estudos Observacionais como Assunto , Estudos Retrospectivos , Estudos Transversais
11.
Med. infant ; 20(2): 117-121, jun. 2013. tab, graf
Artigo em Espanhol | LILACS | ID: lil-774384

RESUMO

El síndrome de Sotos se caracteriza por macrosomía, retraso del desarrollo, rasgos faciales típicos y alteraciones cerebrales. En el año 2002 se identificó al gen responsable de ésta patología NSD1, localizado en el brazo largo del cromosoma 5 (5q35.2-q35.3). El objetivo del trabajo fue describir las curvas de crecimiento de 6 niños con diagnóstico clínico de síndrome de Sotos seguidos en los Servicios de Crecimiento y Desarrollo y Genética del Hospital de Pediatría J. P. Garrahan. Material y Métodos: Se realizó un estudio de serie de casos, retrospectivo, observacional, descriptivo por revisión de historias clínicas, de los datos antropométricos (peso, estatura, perímetro cefálico, longitud tronco, estatura de ambos padres) edad ósea, desarrollo puberal y características clínicas. Se analizaron las curvas de distancia. Se calculó la diferencia de puntaje z de estatura y perímetro cefálico al nacer, 2, 6 años y al final del seguimiento. Resultados: la mediana de peso y longitud corporal al nacer fue estadísticamente mayor que la población argentina (p<0,05). Durante el primer y segundo año de vida se observó aceleración del crecimiento, siendo más evidente en estatura y perímetro cefálico que en peso. Luego de esa edad todos los niños mostraron macrocefalia y el 83% (5/6) alta estatura para la población con crecimiento normal. La mediana de puntaje z de IMC fue 0,61 (r: 0,12/1,80). Todos los niños mostraron tendencia a miembros largos. 67% presentó edad ósea avanzada. Uno de cinco niños mostró inicio puberal temprano: 9,21 años de edad. Conclusiones: La curva de crecimiento de estos seis niños con diagnostico de síndrome de Sotos muestran un patrón similar. La macrocefalia y alta estatura, presentes a partir de los dos años de edad, fue la principal característica de estos niños. El IMC fue normal en todos los niños.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Pré-Escolar , Deficiências do Desenvolvimento/complicações , Deficiências do Desenvolvimento/diagnóstico , Encefalopatias/complicações , Seguimentos , Crescimento e Desenvolvimento , Desenvolvimento Musculoesquelético , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/genética , Argentina , /genética
12.
Rev. méd. Chile ; 139(11): 1444-1450, nov. 2011. ilus
Artigo em Espanhol | LILACS | ID: lil-627574

RESUMO

Background: Metabolic control of diabetic pregnant women is assessed using glycated hemoglobin (HbAlc) levels and fasting blood sugar. Another glycated protein, namely fructosamine, can be an indicator of average glucose levels during the last three weeks. Aim: To evaluate plasma fructosamine as an indicator of glycemic control in women with gestational diabetes. Patients and Methods: Prospective cohort study of 41 pregnant women aged 30 to 37 years, with gestational and pre-gestational diabetes. Blood glucose, HbAlc, fructosamine were measured. Newborn weight, and other prenatal and postnatal variables, were used to evaluate the correlation between metabolic control and the presence or absence of macrosomia. Results: The correlation observed between fructosamine and fasting blood glucose (r = 0.627, p < 0.001) was superior to that of HbA1c and blood glucose (r = 0.516, p < 0.001). No association was observed between macrosomia and levels of fructosamine, nor between the other studied variables. Conclusions: Fructosamine levels were not associated with macrosomia, but it could be better for the evaluation of glycemic control in patients with gestational diabetes since it allows short-term monitoring.


Assuntos
Adulto , Feminino , Humanos , Gravidez , Glicemia/análise , Diabetes Gestacional/sangue , Jejum/sangue , Macrossomia Fetal/diagnóstico , Frutosamina/sangue , Hemoglobinas Glicadas/análise , Biomarcadores/sangue , Métodos Epidemiológicos
14.
Rev. centroam. obstet. ginecol ; 15(4): 116-121, oct.-dic. 2010. tab
Artigo em Espanhol | LILACS | ID: lil-644079

RESUMO

Antecedentes: la macrosomía neonatal es la principal complicación que sufre el hijo de madre diabética. Objetivo: identificar la relación existente entre la macrosomía neonatal y el diagnóstico tardío de la diabetes gestacional (DG), el exceso de peso al inicio del embarazo, la ganancia excesiva de peso durante la gestación, el mal control glucémico, la hipertrigliceridemia y la hipercolesterolemia, y un peso fetal mayor que 97 percentil al inicio del tercer trimestre en el embarazo complicado con DG...


Assuntos
Gravidez , Diabetes Gestacional/diagnóstico , Macrossomia Fetal/diagnóstico , Gravidez em Diabéticas
15.
Rev. centroam. obstet. ginecol ; 14(1): 5-10, ene.-mar. 2009.
Artigo em Espanhol | LILACS | ID: lil-644067

RESUMO

La macrosomía neonatal es la complicación más frecuente que sufre el hijo de madre diabética y su presencia se asocia con un importante aumento de la morbimortalidad perinatal. El responsable principal de su aparición es el hiperinsulinismo fetal que aparece como respuesta a la hiperglucemia fetal, la cual es consecuencia de la hiperglucemia materna. El diagnóstico prenatal de esta alteración se hace en la actualidad por medio de la ecografía fetal, la cual permite calcular el peso del feto con bastante exactitud...


Assuntos
Recém-Nascido , Diabetes Mellitus , Ecocardiografia , Hiperglicemia/etiologia , Hiperinsulinismo/complicações , Macrossomia Fetal/diagnóstico , Macrossomia Fetal/prevenção & controle , Mortalidade Perinatal
16.
Ginecol. obstet. Méx ; 66(10): 420-2, oct. 1998. tab
Artigo em Espanhol | LILACS | ID: lil-232589

RESUMO

Evaluar el método de Johnson y Toshach para predecir el peso fetal. Se incluyeron 200 pacientes con embarazos de término. Se realizó el método clínico de Johnson y Toshach para calcular el peso fetal y se comparó con el peso neonatal inmediato. Se analizaron los resultados mediante la prueba t Student para datos apareados, con intervalo de confiabilidad de 95 por ciento. Se aceptó la técnica como útil en los casos sin diferencias significativas. Ciento cincuenta casos (75 por ciento) se encontraban en trabajo de parto. Las edades gestacionales fueron 38 semanas en 62 casos; 39 semanas, 56 casos; 40 semanas, 60 casos; 41 semanas, 22 casos. El peso promedio fetal vs el peso neonatal fue: a las 38 semanas de 3,164 g (DS 289 g) vs 3,218 g (DS 364 g) (p>.05); a las 39 semanas de 3,175 G (DS 301 g) vs 3,326 g (DS 391 g) (p<0.05); a las 40 semanas de 3,281 g (DS 404 g) vs 3,385 g (DS 461 g) (p<0.05); a las 41 semanas 3,282 g (DS 308 g) vs 3,298 g (DS 267 g) (p>0.05). De los casos en los que hubo diferencia signficativa, 85 por ciento tenían trabajo de parto. El médico de Johnson y Topshach es útil para predecir el peso fetal, en pacientes en embarazo a término, sin trabajo de parto


Assuntos
Humanos , Gravidez , Recém-Nascido , Peso ao Nascer , Desenvolvimento Fetal , Previsões , Recém-Nascido de Baixo Peso , Apresentação no Trabalho de Parto , Macrossomia Fetal/diagnóstico , Terceiro Trimestre da Gravidez , Estudos Prospectivos
18.
Rev. méd. Chile ; 123(12): 1531-8, dic. 1995. tab
Artigo em Espanhol | LILACS | ID: lil-173297

RESUMO

The aim of this work was to compare the nutritional classification of pregnant women and their predictive value for the low birth weight, using the criteria of the Ministry of health (Rosso-Mardones curves) with the curves developed at the Department of Nutrition of the Faculty of Medicine and the body mass index. One thousand eight hundred four pregnancy women of the Metropolitan Region, that were devoid of factors affecting birth weight, were studied retrospectively. Initial and final nutritional status was calculated according to the three criteria in study. Results showed that 47 to 75 percent of women classified as undernourished using Rosso-Mardones curves, were normal according to the curves of the Department of Nutrition and body mass index. Rosso-Mardones curves had the lower predictive value, relative risk and risk attributable to maternal nutritional deficit, for low birth weight. Also these curves showed a higher of obesity and a low predictive value for macrosomia. It is concluded that the curves used by the Ministry of Health must be revised


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Complicações na Gravidez/fisiopatologia , Distúrbios Nutricionais/diagnóstico , Estado Nutricional/fisiologia , Índice de Massa Corporal , Macrossomia Fetal/diagnóstico , Nutrição Materna/normas , Previsões/métodos , Recém-Nascido de Baixo Peso/fisiologia
19.
Rev. obstet. ginecol. Venezuela ; 55(1): 9-6, mar. 1995. tab
Artigo em Espanhol | LILACS | ID: lil-162539

RESUMO

Con el objeto de evaluar la utilidad diagnóstica de parámetros biométricos ecográficos de macrosomía fetal, se estudiaron prospectivamente 200 pacientes de alto riesgo, un grupo estudio de 100 con neonatos macrosómicos y un grupo control de 100 con recien nacidos de pesos adecuados a la edad gestacional. La biotemetría incluyó peso fetal estimado, índice ponderal fetal, circunferencia cefálica, circunferencia abdominal y longitud del femur. Al comparar los dos grupos todas las variables biometricas mostraron diferencias estadísticamente significativas. En eficacia diagnóstica destacó el peso fetal estimado, con sensibilidad 92 por ciento, especificidad 82 por ciento, valor predictivo positivo 83 por ciento, valor predictivo negativo 91 por ciento y exactitud 87 por ciento; la especificidad en general fue alta para todos los parámetros oscilando entre 82 por ciento y 99 por ciento. El análisis de la curva operativa receptora reveló el peso estimado con el de mayor utilidad diagnóstica de macrosomía fetal


Assuntos
Recém-Nascido , Humanos , Feminino , Perinatologia , Ultrassom/métodos , Idade Gestacional , Feto , Macrossomia Fetal/diagnóstico
20.
Rev. obstet. ginecol. Venezuela ; 54(2): 77-9, 1994. tab
Artigo em Espanhol | LILACS | ID: lil-234620

RESUMO

Con el objeto de evaluar la utilidad diagnóstica de macrosomía fetal empleando la relación fémur por 100/circunferencia abdominal fetal, se estudiaron dos grupos de gestantes 100 con productos macrosómicos y 100 con peso adecuado a la edad gestacional. El valor promedio en el grupo estusiado fue 20,33 por ciento ñ 1,31 DE y el grupo control 21,61 por ciento ñ 1,27 DE, diferencia significativa (p<0,001). La evaluación diagnóstica reveló una sensibilidad de 41 por ciento, valor predictivo de prueba positiva de 83 por ciento, y una especificidad de 92 por ciento. Se concluye que dadas las aceptables cifras de seguridad diagnóstica se puede incorporar esta evaluación a los parámetros para determinar macrosomía fetal, con la ventaja que esta independiente de edad gestacional


Assuntos
Humanos , Feminino , Gravidez , Ultrassom , Gravidez , Abdome , Fêmur , Feto/anormalidades , Estatística/métodos , Macrossomia Fetal/diagnóstico , Ginecologia , Obstetrícia
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