الفهرس 
MacrosomiaOnly 14 pages are availabe for public view
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Abstract
The antenatal diagnosis of fetal macrosomia remains problematic despite continuing advances in obstetric ultrasound. Commonly defined as a birth weight of 4000 g or higher, fetal macrosomia is associated with increased maternal and neonatal morbidity.
Studies of ultrasound for prediction of fetal size published during the 1990s generally showed no improvement over clinical techniques. More recent data, however, suggest that ultrasound may have an increased positive predictive value for diagnosing macrosomia when the amniotic fluid index (AFI) is also considered.
The aim of our study is to evaluate if addition of amniotic fluid index (AFI) to estimated fetal weight (EEW) in US examination in labor before rupture of membranes improves prediction of macrosomia at birth or not.
Our study included 300 patients in1st stage of labor before rupture of membranes from Menofiya University Hospital & Tala Central Hospital.
Exclusion criteria:
Multiple gestations, preterm delivery, maternal hypertension, antepartum hemorrhage and any medical disorder except diabetes mellitus.
The following was done for all the patients:
1-History was obtained.
2-Examination was done:
Summary
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-General examination was performed for detection of any systemic disease and measuring vital signs and body mass index of the patient.
-Abdominal (obstetric) examination: Fundal level, Fundal grip, lateral grip and pelvic grips for detection of gestational age, lie, presentation, position and expected weight of the fetus.
-Vaginal examination to confirm presentation and position of the fetus and assess dilatation, position and effacement of the cervix and also to exclude rupture of membranes.
3-Routine investigations:
-Blood group and Rh factor.
-Complete blood count.
-Random blood sugar.
4- The ultrasonography was performed in Menofiya University Hospital by the machine IBE2500D, with convex probe (3.5 – 5.5) MHZ frequency. In Tala Central Hospital, it was performed by Sonata plus machine, with convex probe (3.5) MHZ frequency.
Amniotic fluid index was estimated by measuring the summation of the deepest vertical pocket of amniotic fluid in four quadrants of maternal abdomen free of umbilical cord and fetal extremities.
Fetal weight was estimated by measuring biparietal diameter, abdominal circumference and femur length.
Follow up of the patients during labor was done and the data were recorded, then all data were tabulated and analyzed statistically to evaluate prediction of fetal macrosomia by measuring estimated fetal weight and amniotic fluid index individually and in combination.
Summary
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The results of this work were:-
A) The cut off value of EFW was (4000 g). A positive correlation between EFW and birth weight was detected (r = 0.776, P = 0.001). The area under the ROC curve for EFW as a predictor of macrosomia at birth was (0.93), with sensitivity (46.9%), specificity (98.1%), PPV (75%), (NPV) (93.3%), accuracy (92.7%) and likelihood ratio (24.7%).
B) The cut off value of AFI was (16.4 cm). There was also positive correlation between AFI and birth weight (r = 0.39, P = 0.0001). The area under the ROC curve for AFI as a predictor of macrosomia at birth was (0.67), sensitivity (63%), specificity (79%), PPV (27%), NPV (95%), accuracy (78%) and likelihood ratio (21%).
C) The sensitivity of combined EFW & AFI was (37.5%), specificity (99.6%), PPV (92.3%), NPV (93.3%), accuracy (93%) and likelihood ratio (93.7%).
As noted: the PPV and likelihood ratio for EFW & AFI in combination are higher than that for each parameter individually which confirms that both tests together are more valuable.