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Query: UMLS:C0011849 (diabetes)
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Fetal macrosomia (birthweight equal to or in excess of 4500 g) in a study of 110 affected infants was associated with excessive maternal weight, prolonged gestation, white race, multiparity, maternal diabetes, male fetus, and a previous macrosomic infant. The two most common obstetric complications associated with fetal macrosomia were postpartum hemorrhage and shoulder dystocia. One-minute Apgar score was less than 7 in 10.9% of the macrosomic infants, in contrast to 6.3% for the smaller infants studied as controls. The low fetal mortality rate (1.8%) was attributed to a 22.5% cesarean rate for the macrosomia group. Even more frequent use of abdominal delivery might further reduce obstetric and neonatal complications for macrosomic infants.
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PMID:Macrosomia. A proposed indication for primary cesarean section. 30 70

Shoulder dystocia is an infrequently encountered obstetric emergency varying in incidence from 0.15 to 0.60% of all deliveries. Previously identified risk factors include maternal obesity, previous infants weighing greater than 4 kg, maternal diabetes, and fetal macrosomia (greater than 4 kg). To evaluate the role of prolonged second stage of labor (PSS) as a warning sign for shoulder dystocia, 9864 deliveries at LAC-USC Women's Hospital were retrospectively reviewed. Ninety percent delivered vaginally and 4.89% had PSS with midpelvic delivery. Shoulder dystocia occurred in 0.37% of all vertex vaginal deliveries. In the absence of PSS and midpelvic delivery, the incidence of shoulder dystocia was 0.16%. However, with PSS and midpelvic delivery, the incidence of shoulder dystocia was 4.57% (P less than 0.01). Infants weighing in excess of 4 kg were at increased risk of shoulder dystocia compared with infants weighing less than 4 kg. When PSS occurred and midpelvic delivery was attempted, the incidence of shoulder dystocia was 21% in infants weighing in excess of 4 kg; 8% had had failed vaginal delivery. All shoulder dystocias and failed vaginal deliveries occurred after use of the vacuum extractor. Immediate neonatal injury was apparent in 47% of infants with shoulder dystocia after PSS with midpelvic delivery. There were no maternal or fetal deaths related to shoulder dystocia during the study period.
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PMID:Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. 72 69

A nine-year review of 103 cases of shoulder dystocia identified obesity, diabetes mellitus and post-datism as important predisposing risk factors. There was a positive correlation with birthweight. Abnormal labour patterns were invariably absent and perinatal outcome was disastrous. The best strategy is to anticipate and avoid this obstetrical emergency.
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PMID:Shoulder dystocia: an obstetrical nightmare. 129 Feb 37

A prospective study was carried out in the Maternity Hospital, Kuala Lumpur in 1989 to determine the morbidity and mortality of infants of diabetic mothers. Out of 24,856 neonates born during the study period, 54 neonates (2.2 per 1000 livebirths) were born to mothers who were diagnosed to have diabetes mellitus before the current pregnancy or who had impaired glucose tolerance test during the current pregnancy. Almost a third (29.6 percent) of these infants of diabetic mothers had birthweight of 4000 grams and above, and 37.0 percent of the 54 babies were large-for-gestational age. Hypoglycemia occurred in 9/54 (16.7 percent) of the neonates, respiratory distress syndrome in 5/54 (9.3 percent), shoulder dystocia in 7/54 (13.0 percent), and congenital abnormalities in 4/54 (7.4 percent). Three (5.6 percent) neonates died during the neonatal period. The results of this study suggest a need to intensify control of maternal diabetes mellitus during pregnancy in order to reduce the rates of morbidity and mortality of their infants.
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PMID:Morbidity and mortality of infants of diabetic mothers born at the Maternity Hospital, Kuala Lumpur. 138 51

Researchers analyzed data on 2395 hospital births which occurred to 2328 14-49 year old women between January 1984 and May 1989 living in 7 parishes of Jamaica to determine the prevalence and factors of cesarean section. The primary cesarean section rate for the 5.5-year period was 4.1% which is lower than the rates of some developing countries and of some developed countries such as the US. The repeat cesarean section rate was 1.3%. Cephalopelvic disproportion and/or prolonged labor (abnormal labor) accounted for 17.4% of all primary cesarean sections. Abnormal labor carried the greatest risk of primary cesarean section (logistic regression model beta=1.9). Other delivery complications which posed considerable risk of cesarean section included breech presentation (beta=1.68), maternal diabetes (beta=0.84), maternal hypertension (beta=0.47), large birth weight infant (beta=0.4), and low birth weight infant (beta=-0.15). These complications made up 22.3%, 7.1%, 7.4%, and 5.3% of all primary cesarean sections, respectively. Nonmedical determinants of primary cesarean section included 30-year old women (beta=1.04), 1-2 births (beta=-1.27), urban residence (beta=0.75), and delivering in a private hospital (beta=0.59). 5.3% of 30-year old mothers underwent a cesarean section compared with 3.8% of 30-year old mothers. 5.2% of women of parity 1-2 had a cesarean section whereas only 2.3% of those of parity =or 3 did. Urban mothers were more likely to have a cesarean section than were rural mothers (5.4% vs. 3.3%). 7.6% of mothers delivering at a private hospital underwent a cesarean section compared with 3.9% of those delivering at a government hospital. Well-designed studies of infant mortality in Jamaica can determine whether the country can attain low levels of early infant mortality while keeping its current low rate of cesarean section.
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PMID:Prevalence and determinants of caesarean section in Jamaica. 142 79

Shoulder dystocia is a serious obstetric emergency with several cases of permanent disability and fetal deaths each year. Ninety-eight cases of shoulder dystocia, an incidence of 0.45%, occurred in Farwania Hospital, Kuwait during 1985-1987. Of these 54.1% had one or more birth trauma. The perinatal mortality rate was 71.4 per thousand, with a considerable increase in the rate of maternal complications. Macrosomia, maternal diabetes, augmentation and induction of labor, vacuum extraction, post-term and malposition, were identified risk factors. We found that if all babies weighing greater than or equal to 4.5 kg are delivered by cesarean section, dystocia can be significantly reduced.
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PMID:Shoulder dystocia: anticipation and outcome. 167 Oct 25

The purpose of this paper is to determine the incidence of fetal macrosomia, analyze risk factors, and review maternal and fetal outcome. Macrosomia occurred in 15.1% of deliveries, with very macrosomic fetuses comprising 4.1% of these pregnancies; 61.3% were male. Diabetes mellitus, post-term pregnancy, and excessive weight gain were identified as maternal risk factors. The incidence of shoulder dystocia, birth injury, and low Apgar scores was significantly higher than in controls. In addition, cesarean section rates were higher for the macrosomic groups. Fetuses delivered vaginally had more frequent birth injury than those delivered by cesarean section. Women at risk for fetal macrosomia should be screened, and liberal use of cesarean section is recommended.
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PMID:Fetal macrosomia in a military hospital: incidence, risk factors, and outcome. 190 May 88

A total of 75,979 women who were delivered vaginally in the period 1970 to 1985 were stratified into diabetic and nondiabetic groups. Overall, the incidence of macrosomia (greater than or equal to 4000 gm) was 7.6% (5674/74390) in the nondiabetic group and 20.6% (328/1589) in the diabetic group. Patients were further subdivided by weight categories at 250 gm intervals. Eight percent of shoulder dystocia occurred in the diabetic group when fetal weight was greater than or equal to 4250 gm. In contrast, 20% of shoulder dystocia in the nondiabetic group could have been prevented by elective cesarean section when the fetal weight was greater than or equal to 4500 gm. Furthermore, logistic regression analysis demonstrated that birth weight, diabetes, and labor abnormalities were the principal contributors to shoulder dystocia. Elective cesarean section is strongly recommended for diabetics with fetal weights greater than or equal to 4250 gm, and trial of vaginal delivery for nondiabetic fetuses with weights greater than or equal to 4000 gm is recommended. In all cases the clinician must be watchful for labor abnormalities in macrosomic fetuses.
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PMID:Shoulder dystocia: should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section? 195 39

Two hundred eighty-four macrosomic babies of 4000 g or over at birth were compared with an equal number of appropriate weight term infants, to identify maternal risk factors and fetal outcome. Maternal obesity, grand multiparity, diabetes mellitus and postmaturity were the major maternal risks. Prolonged labor, shoulder dystocia and injury to infant following instrumental delivery for mid-cavity arrest were the major fetal risks. A protocol for management of fetal macrosomia is proposed.
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PMID:Fetal macrosomia--maternal risks and fetal outcome. 197 12

Shoulder entrapment during delivery is a true obstetric emergency that can result in significant maternal and infant trauma. Fetal macrosomia, maternal obesity, maternal diabetes and prolonged second stage of labor are associated risk factors. Infant complications of shoulder dystocia include traumatic brachial plexus injury, humeral fracture, clavicular fracture and severe birth asphyxia. With fetal shoulder entrapment, the mother may have significant hemorrhage, fourth-degree perineal lacerations and endometritis. Maneuvers to release the shoulder include closed-fist suprapubic pressure, downward pressure on the posterior shoulder, rotation of the anterior shoulder to the oblique position, rotation of the posterior shoulder beneath the pubic symphysis, release of the posterior arm and anterior rotation of the fetal body.
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PMID:Shoulder dystocia. 200 18


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