Área del cordón umbilical medida por ecografía como predictor de macrosomía fetal

Rommel Omar Lacunza Paredes

doi:10.31403/rpgo.v59i59

Authors

Rommel Omar Lacunza Paredes Médico Gineco-Obstetra, Asistente del Servicio de Ginecología-Obstetricia, Hospital Nacional Daniel Alcides Carrión, Callao-Perú

DOI:

https://doi.org/10.31403/rpgo.v59i59

Abstract

Objective: To demonstrate that the umbilical cord area measured by ultrasound is a predictor of fetal macrosomia in term singleton fetuses. Design: Descriptive, observational, cross sectional study. Setting: Hospital Nacional Daniel Alcides Carrion, Callao, Peru. Participants: Pregnant women at term. Interventions: Ultrasound anthropometric parameters, Hadlock formula, Cromi formula and cross-sectional area in a free loop of the umbilical cord were determined in 181 pregnant women at term with single fetus. Logistic regression was used to determine predictors of fetal macrosomia. Main outcome measures: Prediction of fetal macrosomia. Results: The prevalence of fetal macrosomia detected by ultrasound was 41.9%. The proportion of cases of umbilical cord area above the 95th percentile was significantly higher in cases of infants with macrosomia (85% versus 34.2%). The multiple regression model demonstrated the independent contribution of the umbilical cord area above the 95th percentile as a predictor of macrosomia with sensitivity 86.6%, specificity 65.7%, positive predictive value 64.35% and negative predictive value 86%. The ROC curve showed the area under the curve of the umbilical cord area above the 95 percentile was higher (0.75) than the ultrasound fetal weight by Hadlock formula (0.74). Conclusions: The umbilical cord area above the 95th percentile for gestational age is a good predictor of fetal macrosomia in term singleton fetuses. Keywords: Fetal macrosomia, umbilical cord, ultrasonography.

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References

American College of Obstetricians and Gynecologists. Fetal macrosomia. Practice Bulletin No. 22. ACOG: Washington, DC, 2000.

Ng SK, Olog A, Spinks AB, Cameron CM, Searle J, McClure RJ. Risk factors and obstetric complications of large for gestational age births with adjustments for community effects: results from a new cohort study. BMC Public Health. 2010;6(10):460.

Ju H, Chadha Y, Donovan T, O¨Rourke P. Fetal macrosomia and pregnancy outcomes. Aust N Z J Obstet Gynaecol. 2009;49(5):504-9.

Chauhan SP, Grobman WA, Gherman RA, Chauhan VB, Chang G, Magann EF. Suspicion and treatment of the macrosomic fetus: a review. Am J Obstet Gynecol. 2005;193:332–46.

Hadlock FP, Harrist RB, Sharman RS, Deter RL. Estimation of fetal weight with the use of head, body, and femur measurements – a prospective study. Am J Obstet Gynecol. 1985;151:333–7.

Hart NC, Hilbert A, Meurer B, Schrauder M, Schmid M, Siemer J, Voigt M. Macrosomia: a new formula for optimized fetal weight estimation. Ultrasound Obstet Gynecol. 2010;35(1):42-7.

Hoopmann M, Abele H, Wagner N, Wallwiener D, Kagan KO. Performance of 36 different weight estimation formulae in fetuses with macrosomia. Fetal Diagn Ther. 2010;27(4):204-13.

Rosati P, Arduini M, Giri C, Guariglia L. Ultrasonographic weight estimation in large for gestational age fetuses: a comparison of 17 sonographic formulas and four models algorithms. J Matern Fetal Neonatal Med. 2010;23(7):675-80.

Lindell G, Källén K, Marsál K. Ultrasound weight estimation of large fetuses. Acta Obstet Gynecol Scand. 2012;91(10):1218-25.

Lalys L, Grangé G, Pineau JC. Estimation of small and large fetal weight at delivery from ultrasound data. J Gynecol Obstet Biol Reprod. 2012;41(6):566-73.

Melamed N, Yogev Y, Mizner I. Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med. 2010;29(2):225-30.

Milnerowicz-Nabzdyk E, Zimmer M, Tlolka J, Michniewics J, Pomorski M, Wiatrowski A. Umbilical cord morphology in pregnancies complicated by IUGR in cases of tobacco smoking and pregnancy-induced hypertension. Neuro Endocrinol Lett. 2010;31:842-7.

Binbir B, Yeniel AO, Ergenoglu AM, Kazandi M, Akercan F, Sagol S. The role of umbilical cord thickness and HbA1c levels for the prediction of fetal macrosomia in patients with gestational diabetes mellitus. Arch Gynecol Obstet. 2012;285(3):635-9.

Raio L, Ghezzi F, Di Naro E, Franchi M, Bolla D, Schneider H. Altered sonographic umbilical cord morphometry in early-onset preeclampsia. Obstet Gynecol. 2002;100:311–6.

Barbieri C. Area of Wharton’s jelly as an estimate of the thickness of the umbilical cord and its relationship with estimated fetal weight. Reproductive Health. 2011;8:32.

Raio L, Ghezzi F, Di Naro E, Gomez R, Franchi M, Mazor M, Bruhwiler H. Sonographic measurement of the umbilical cord and fetal anthropometric parameters. Eur J Obstet Gynecol Reprod Biol. 1999;83:131–5.

Cromi A, Ghezzi F, Di Naro E. Large cross-sectional área of the umbilical cord as a predictor of fetal macrosomia. Ultrasound Obstet Gynecol. 2007;30:861–6.

Barbieri C, Cecatti JG, Krupa F, Marussi EF, Costa JV. Validation study of the capacity of the reference curves of ultrasonographic measurements of the umbilical cord to identify deviations in estimated fetal weight. Acta Obstet Gynecol Scand. 2008;87(3):286-91.

Ghezzi F, Raio L, Di Naro E, Franchi M, Balestreri D, D’Addario V. Nomogram of Wharton’s jelly as depicted in the sonographic cross section of the umbilical cord. Ultrasound Obstet Gynecol. 2001;18:121–5.

Barbieri C, Cecatti J, Surita F, Marussi E, Costa E. Sonographic measurement of the umbilical cord area and the diameters of its vessels during pregnancy. J Obstet Gynecol. 2012;32(3):230-6.