Fetal macrosomia greater than or equal to 4000 grams. Comparing maternal and neonatal outcomes in diabetic and nondiabetic women.

OBJECTIVE: To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women. METHODS: A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic (group 1, n=207) and nondiabetic (group 2, n=559) women. RESULTS: There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women (30.4% versus 19.5%, p=0.002). There were no significant differences between either group in total maternal morbidity (12.6% versus 14.1%, p=0.7). There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women (1.9% versus 0.2%, p=0.03). CONCLUSION: Elective cesarean delivery for estimated fetal weight > or =4500g for nondiabetic women and > or =4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates.

Ovarian reserve, response to gonadotropins, and oocyte maturity in women with malignancy.

OBJECTIVE: To study the ovarian reserve, ovarian response to gonadotropins, and oocyte maturity in women with cancer undergoing in vitro fertilization (IVF) before chemotherapy or radiotherapy. DESIGN: Case-control study. SETTING: University teaching hospital. PATIENT(S): We evaluated all women with malignancy who underwent fertility preservation from the year 2003 to 2010. We compared 41 women with cancer undergoing IVF treatment with a control group of 48 age-matched women undergoing IVF for male factor infertility with the same protocol. INTERVENTION(S): In vitro fertilization. MAIN OUTCOME MEASURES(S): Ovarian reserve, ovarian response to gonadotropins, number of oocytes retrieved, and oocyte maturity. RESULT(S): There were no significant differences in age, antral follicle count, serum FSH, total dose of gonadotropins required for stimulation, duration of stimulation, or peak E(2) levels on the day of hCG administration between women with cancer and the control group. No significant differences were observed in the number of retrieved oocytes between the malignancy and control groups. The percentages of mature oocytes in patients with hematologic malignancy (83.3%), gynecologic and intestinal malignancy (94%), and brain cancer (86%) and in the control group (82.1%) were similar, as were the fertilization rates. CONCLUSION(S): In young women with malignancy, ovarian reserve, response to gonadotropins, oocytes retrieved, and oocyte maturity remain unaltered by the neoplastic process. This is in contrast to the impairment of spermatogenesis before therapy in men with cancer.

Ovarian reserve and oocyte maturity in women with malignancy undergoing in vitro maturation treatment.

OBJECTIVE: To evaluate ovarian reserve and oocyte maturity in women with malignancy. DESIGN: A case-control study. SETTING: University teaching hospital. PATIENT(S): We evaluated all women with malignancy who underwent in vitro maturation treatment for fertility preservation from the year 2003 to 2009. The results were compared with those of an age-matched infertile control group. INTERVENTION(S): In vitro maturation treatment. MAIN OUTCOME MEASURE(S): Ovarian reserve and oocyte maturity. RESULT(S): Women with malignancy of the breast (n = 87), hematologic malignancy (n = 16), gynecologic or abdominal malignancy (n = 9), and other malignancies (n = 16) were compared with infertile control women (n = 79). The age was similar in all groups except in women with hematologic malignancy where they were younger than the control group (24.9 ± 1.1 years vs. 30.8 ± 0.4 years, confidence interval 4.0-9.5). Baseline FSH in this group was also lower than in the control group. Women with breast cancer had a lower number of retrieved oocytes than the control group (95% confidence interval 0-5). There were no significant differences in antral follicle count, percentage of mature oocytes on collection day, and percentage of metaphase II oocytes matured in vitro among all groups of women. CONCLUSION(S): Women with breast cancer have fewer numbers of retrieved oocytes than infertile controls. Ovarian reserve and oocyte maturity in other types of malignancy are similar to those in the control group.