Sonographic fetal asymmetry predicts shoulder dystocia.

OBJECTIVE: The purpose of this study was to evaluate the performance of a sonographic measurement of fetal asymmetry, abdominal diameter minus biparietal diameter (AD - BPD), in the prediction of shoulder dystocia (SD) in a patient population that was unselected for diabetes mellitus (DM) status. METHODS: Patients who underwent sonographic estimations of fetal biometric measurements within 14 days of vaginally delivered live-born singleton neonates weighing 3400 g or greater at a tertiary care institution were included in this retrospective cohort. The mean AD - BPD was retrospectively compared in deliveries complicated by SD with those without SD by the Student t test. A receiver operating characteristic curve was generated to determine the optimal cutoff for SD prediction. Test performance characteristics of AD - BPD were determined. RESULTS: Of 5204 deliveries, 332 met inclusion criteria. Shoulder dystocia complicated 23 deliveries (6.9%). The mean AD - BPD was significantly higher in the dystocia group (2.39 versus 1.97; P = .0002). With an AD - BPD of 2.6 cm or greater, the risk rates of SD were 25% for unselected patients and 38.5% with DM. CONCLUSIONS: An AD - BPD of 2.6 cm or greater identifies a subset of patients with and without DM at risk for SD.

Does size matter? Tumor size and morphology as predictors of nodal status and recurrence in endometrial cancer.

OBJECTIVE: To determine whether tumor size or morphology is predictive of extrauterine disease and/or recurrence risk in endometrial cancer and therefore guide decisions about the necessity of complete surgical staging and adjuvant therapy. METHODS: All women with surgically treated endometrial carcinoma between 1 January 1990 and 1 January 2000 were eligible. 345 patients were eligible for retrospective chart review. Univariate and multivariate logistic regression models were used to determine the predictors of nodal metastasis and recurrence. RESULTS: As tumor size increased, the risk of nodal metastasis increased. However, a risk of nodal metastasis remained even with small lesions less than or equal to 2 cm (6.3% risk). Patients with tumor size greater than 2 cm had a 26.3% incidence of nodal metastasis. In univariate analysis, the odds ratio (OR) for tumor size as a predictor of extrauterine disease was 1.4 (95% CI 1.2-1.6). In multivariate analysis, tumor size was not statistically significant. Only the lesions greater than or equal to 8 cm confer a risk that approaches previously identified well-known predictors. Tumor size was not found to be a statistically significant predictor of recurrence OR 1.3 (1.0-1.8). CONCLUSIONS: Tumor size correlates with extrauterine disease, but it is not an independent prognostic variable. Although the risk of extrauterine disease increases with tumor size, the risk of nodal metastases remains even for those patients with very small tumors, underscoring the need for routine complete surgical staging. Tumor size does not appear to be an independent predictor of recurrence.

Increased risk of adverse pregnancy outcome among Somali immigrants in Washington state.

OBJECTIVE: The purpose of this study was to compare maternal and neonatal morbidity among Somali immigrants, US-born blacks and whites in Washington state. STUDY DESIGN: Washington state birth certificate data was linked to hospital discharge records comparing singleton deliveries among Somali immigrants with US-born blacks and whites between 1993 and 2001, in a 1:3 ratio. Outcomes were compared using unconditional multiple logistic regression models calculating odds ratios (ORs), and 95% confidence intervals (95% CIs). RESULTS: Five hundred seventy-nine pregnancies from Somali women were compared with 2384 and 2435 pregnancies from black and white women, respectively. Nulliparous Somali women were more likely to have a cesarean delivery than black or white control women, OR 1.6 (95% CI, 1.1-2.3) and 2.0 (95% CI, 1.4-2.8), respectively. Among all women who had cesarean deliveries, Somali women more commonly had cesarean deliveries associated with fetal distress and failed induction of labor. They were 9 times more likely than both control groups to deliver after 42 weeks gestation, and 4 times more likely than black women and 8 times more likely than white women to have oligohydramnios. Somali women were more likely to have gestational diabetes and significant perineal lacerations, and less likely to smoke. Newborns of Somali women were at increased risk for prolonged hospitalization, lower 5-minute Apgar scores, assisted ventilation, and meconium aspiration. CONCLUSION: Pregnancy outcomes should be evaluated within ethnically and culturally unique groups; Somali immigrants are a high-risk subpopulation.