Association between pre-pregnancy obesity and the risk of cesarean delivery.

OBJECTIVE: To explore the relationship between pre-pregnancy obesity and the risk for cesarean delivery. METHODS: The population studied included 20,130 women with live births after 20 weeks' gestation in central New York state between June 1, 1994, and May 31, 1995. Women who were obese before pregnancy were compared with nonobese women with regard to mode of delivery. Obesity was defined as body mass index (BMI) greater than 29. Separate analyses were conducted on the entire sample and on a subset of women with singleton pregnancies and no prior cesarean deliveries, as an estimate of the risk of primary cesarean delivery in obese women. Statistical analyses included chi 2 test, crude odds ratio (OR) with 95% confidence interval (CI), and adjusted OR with 95% CI, using logistic regression to control for confounding variables. RESULTS: The adjusted OR was 1.64 (95% CI 1.46, 1.83) for obese women with singleton pregnancies and no prior cesarean deliveries to undergo cesarean delivery. The adjusted OR was 1.66 (95% CI 1.51, 1.82) for obese women in the entire sample to undergo cesarean delivery. In addition, increasing BMI was associated with increased risk for cesarean delivery. CONCLUSION: Compared with nonobese women, women who are obese before pregnancy are at increased risk for cesarean delivery. Preconceptional counseling regarding dietary and life-style modifications may alter this pattern.

Sonographic estimation of fetal body composition with gestational diabetes mellitus at term.

OBJECTIVE: To derive models and equations for estimating fetal lean mass and fat mass in women with gestational diabetes mellitus (GDM), using sonographic techniques and neonatal total body electrical conductivity. METHODS: Twenty women with GDM at term underwent sonographic evaluation within 72 hours before delivery. Sonographic studies included measurements of the fetal biparietal diameter, head circumference, abdominal circumference, anterior and lateral abdominal-wall subcutaneous fat thicknesses, femur length, mid-thigh circumference, and anterior and lateral thigh subcutaneous fat thicknesses. Within 24 hours of birth, the infants were weighed and their body composition estimated with total body electrical conductivity measurements. Volume-based models and regression equations for estimating lean and fat mass were derived. The equations were validated prospectively in the next 16 women with GDM. RESULTS: There were no significant differences in maternal or neonatal demographic or anthropometric data between the derivative and validation groups. The equation for estimating fetal lean mass is: lean mass = 0.169(volume of head) + 0.262(volume of lean trunk) - 308.59 (r = 0.86, P < .01). The equation for estimating fetal fat mass is: fat mass = 0.241(volume of fat sheath of trunk) - 213.13 (r = 0.73, P < .01). In the validation group, the sonographic estimates of fetal lean and fat mass were not significantly different than those estimated by total body electrical conductivity (P = .18 and P = .77, respectively). CONCLUSION: Fetal body composition can be estimated by obtaining several additional measurements during routine fetal sonography.

Persistent urogenital sinus: prenatal diagnosis and pregnancy complications.

Prenatal diagnosis of fetal hydrocolpos caused by persistent urogenital sinus is described. The urethrovaginal communication allowed urine to empty from the bladder into the vagina, which subsequently dilated, causing bilateral hydronephrosis, distention of the fetal abdomen, decreased urinary output, oligohydramnios, and abdominal dystocia at delivery.

The prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment for premature labor or preterm premature rupture of membranes.

OBJECTIVE: This study was undertaken to determine the prevalence of thromboembolic events among women with extended bed rest prescribed as part of the treatment of premature labor or preterm premature rupture of membranes. STUDY DESIGN: A retrospective chart review was undertaken of all women who had bed rest of >/=3 days' duration prescribed as part of the treatment of premature labor or preterm premature rupture of membranes in the Akron General Medical Center Perinatal Unit during the period January 1, 1997-December 31, 1998. The prevalence of thromboembolic events in this population was determined. The charts of all additional gravid women with antepartum or postpartum deep vein thrombosis or pulmonary embolism diagnosed during the study period were also reviewed. The prevalence of these disorders among the pregnant population for whom extended bed rest was not prescribed as part of the treatment of premature labor or preterm premature rupture of membranes was also calculated. Statistical comparison of the prevalences in the 2 populations was undertaken by means of the chi(2) analysis with the Fisher exact test. RESULTS: There were 192 patients admitted during the study period who had extended bed rest prescribed as part of the treatment of premature labor or preterm premature rupture of membranes. Three of these women had thromboembolic events, for a prevalence of 15.6 cases per 1000 women. Five additional gravid women were admitted for the treatment of deep vein thrombosis or pulmonary embolism. There were 6164 deliveries among women not treated with extended bed rest for premature labor or preterm premature rupture of membranes during this period. Thus the prevalence of these phenomena among the remaining pregnant women was 0.8 cases per 1000 women. The prevalences of these disorders in the 2 populations were highly significantly different. CONCLUSION: The prevalence of thromboembolic events among women for whom extended bed rest is prescribed as part of the treatment of premature labor or preterm premature rupture of membranes is significantly increased with respect to that among gravid women who do not receive this therapy and is substantially higher than previously reported. If this finding is confirmed in other populations, it may be prudent to undertake further studies to determine whether this prevalence can be reduced.