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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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

Several maternal plasma fuel abnormalities have been described in gestational diabetes mellitus (GDM), and all may contribute to the development of fetal macrosomia, generally because of the surfeit of calories they provide. Elevated maternal plasma glucose and amino acid concentrations represent key disturbances, because they are also well-known fetal pancreatic beta-cell secretagogues. Fetal hyperinsulinemia contributes to macrosomia in a special way by selectively accelerating fuel utilization and storage in insulin-sensitive fetal tissues. Maternal obesity intensifies the insulin resistance already present in late pregnancy and probably exaggerates the metabolic abnormalities attending GDM that impact on fetal growth and development. However, the means by which maternal obesity per se promotes the development of heavy babies in nondiabetic pregnancies remains poorly defined. Significant correlations exist between newborn birth weight and the levels of maternal plasma glucose, amino acids, free fatty acids, and triglycerides in diabetic pregnancies. However, the relative influence of each disturbance on fetal birth weight remains controversial and requires more detailed investigation.
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PMID:Impact of maternal fuels and nutritional state on fetal growth. 174 67

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

To describe maternal body mass index and to compare the use of maternal weight and body mass index for risk assessment at the initial prenatal visit, 6270 gravid women who were consecutively delivered of infants were studied. Body mass index increased with advancing maternal age, parity, and advancing gestational age and was significantly greater in black women than in nonblack women. Risks for the development of adverse outcome associated with maternal obesity, including development of gestational diabetes, preeclampsia, fetal macrosomia, and shoulder dystocia, were comparably predicted by either maternal weight or body mass index greater than 90th percentile. Maternal weight was as predictive of preeclampsia, macrosomia, and shoulder dystocia as was body mass index when these factors were analyzed as continuous variables, whereas increasing body mass index was more predictive of gestational diabetes. The prediction of factors associated with low maternal weights, small-for-gestational-age birth, prematurity, low birth weight, and perinatal death was equivalent for maternal weight and body mass index that was less than 10th percentile. This study indicates that in the initial risk assessment of outcomes related to maternal weight, the calculation of maternal body mass index offers no advantage over simply weighing the patient. This finding contrasts with results in nonpregnant women.
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PMID:The clinical utility of maternal body mass index in pregnancy. 203 74

The maternal antepartum, intrapartum, and neonatal characteristics of 158 patients with gestational diabetes mellitus (GDM) attending a large teaching hospital between 1979 and 1983 were described and compared with a matched nondiabetic control group. The primary cesarean section rate in patients with GDM (18%) was significantly greater than in the control group (11%, P less than 0.04). Neonatal macrosomia, as reflected in mean birthweight (P less than 0.04), the number of neonates weighing greater than 4 kg (P less than 0.05) and large-for-gestational-age infants (P less than 0.05), and the birthweight adjusted for gestational age (K-score, P less than 0.01) was significantly increased in the diabetic group. The characteristics of patients with GDM treated with diet alone and diet and insulin together were examined. The insulin-therapy group was characterized by more patients older than 25 yr (P less than 0.01) and a higher mean birthweight (3743 +/- 677 g) (P less than 0.02) than the diet-alone group. This may reflect an increased magnitude of glucose intolerance in the insulin-treated group. Obese patients with GDM delivered heavier neonates than the nonobese patients with GDM (P less than 0.01). Although there was no difference between the groups, perinatal mortality was present in this study. These data indicate that the major perinatal morbidity in GDM included increased cesarean section for fetal macrosomia. Early diagnosis with strict diagnostic criteria and rigid antenatal surveillance may result in further improvements in outcome.
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PMID:Gestational diabetes mellitus. Is further improvement necessary? 388 43

Most studies of gestational diabetes mellitus (GDM) have reported a marked reduction in perinatal mortality with appropriate dietary regimens and good medical and obstetrical surveillance. Nevertheless, fetal morbidity, including macrosomia, has remained high and appears to be linked to factors other than plasma glucose control. In a review of six investigations in which insulin therapy was combined with an appropriate diet, the incidence of fetal macrosomia was reduced in five studies as compared with diet-only treatments. Again, the improvement did not always correlate with altered plasma glucose profiles. Other studies suggest that maternal plasma substrate disturbances other than glucose may contribute to the development of fetal macrosomia. To what extent insulin administration reduces morbidity by containing circulating maternal fuels, such as lipids and amino acids, in a more normal range remains to be determined. Moreover, the role of diet, maternal obesity, and weight gain during pregnancy adds to the complexity of factors influencing obstetrical outcome in gestational diabetes. Until the relative importance of all of these variables is adequately assessed, criteria for selection of women with pregnancy-onset diabetes for insulin therapy are most likely to be based on fasting and postprandial plasma glucose concentrations.
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PMID:Therapeutic results of insulin therapy in gestational diabetes mellitus. 388 49

The AA. report the results of 14 years' screening for diabetes type 2 in their Health District (Emilia Romagna, North Italy), according to Pavel's method, for early diagnosis of clinical diabetes and impaired glucose tolerance (IGT). The AA. found in a first screening 1.03% of clinical diabetes and 2.65% of IGT cases in the population examined (200,000 subjects). Statistically significant correlations existed in relation to the various risk factors (hereditary factors, obesity, fetal macrosomia, job). The follow-up after 6 years for IGT subjects showed a 25.5% return to normal oral glucose tolerance test (OGTT) values, 21.7% improvement, 19% unchanged, 33.8% impairment. There was a correlation between these results and life-style (diet, physical exercise, weight loss). Fourteen years after these screening, a 2.7% negative incidence was observed for diabetes type 2 in this Health District.
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PMID:Pavel's "dynamic screening" for diabetes type 2: 14 years results in a district of northern Italy. 399 42

The authors report the results of a 12-year screening for type II diabetes in their Health District (Emilia-Romagna, Northern Italy). The method consisted of two steps, following Pavel and Sdrobici, for early diagnosis of clinical diabetes and IGT. The authors found 1.03% of clinical diabetes and 2.65% of IGT cases in the population examined (200,000 subjects). Statistically significant correlations existed with regard to the various risk factors (familiarity, obesity, fetal macrosomia, occupation). Follow-up after 6 years for IGT subjects showed a 25.5% return to normal of OGTT values, 21.7% improvement, 19% unchanged, 33.8% deterioration. There was a correlation between these results and life-style (diet, reduction in calorie intake, weight loss). Twelve years after these screenings, a 2.7% drop in incidence was observed for type II diabetes in this Health District.
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PMID:Long-term results in preventive medicine for type II diabetes. 407 68

Perinatal morbidity and mortality are known to be higher for the macrosomic neonate whose birth weight is 4500 g or more, compared with that of appropriate-weight term-size neonates. In a retrospective study comparing 287 macrosomic neonates with 284 appropriate-weight term-size neonates, we found that macrosomia occurred in 1.3% of our annual deliveries, with a male-to-female ratio of 2.3:1. Factors that occurred significantly more frequently in the mothers of macrosomic infants were maternal obesity, multiparity, diabetes mellitus, and previous delivery of an infant heavier than 4000 g. During the intrapartum period the incidence of labor augmentation by oxytocin, shoulder dystocia, and cesarean section was significantly greater in fetal macrosomia. Most significantly, this study revealed that macrosomia. Most significantly, this study revealed that macrosomic fetuses do not experience greater fetal distress in biophysically monitored labor than appropriate-weight term-size fetuses. Twenty-nine (10%) of the macrosomic infants required admission to the neonatal intensive care unit (NICU) compared to 9 (3%) of the control patients (P less than 0.01). This excess neonatal morbidity in the macrosomic neonates was predominantly caused by the delivery process.
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PMID:Macrosomia--maternal, fetal, and neonatal implications. 736 96


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