الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 115 |  |  |
| | | from | 115 | | |
Abstract
Summary
The umbilical cord is responsible for maternal fetal blood flow. Normally, it is composed of two arteries permeated with venous blood and a vein that transports arterial blood, cushioned by a special type of mucous connective tissue known as Wharton’s jelly (WJ) and by remnants of the allantoids. There is a significant differences in mean gestational age, mode of delivery, birth weight and adverse perinatal outcome between fetuses with umbilical cord thickness below the 5th percentile (lean umbilical cord) vs those with umbilical cord thickness above the 5th percentile (non-lean cord) in the first and early second trimesters of gestation.
The umbilical cord, which provides a structural and functional connection between the fetus and the placenta, seems simple but its importance for the development of the fetus is unquestionable. The relationship between the placenta and the fetus is enabled through the umbilical cord, and ultrasonographic examination of umbilical cord is usually limited to Doppler blood flow and assessment of the number of vessels.
Also, the effect of umbilical cord morphology on the fetus and neonates has not been adequately shown. A limited number of studies have shown that umbilical cord morphology and its components could affect the progress of pregnancy, the method of delivery and neonatal outcomes. Also, some other studies have shown that the presence of a lean umbilical cord in the second trimester may cause low birth weight and result in more fetal distress in labor.
The birth of a macrosomic fetus has been associated with adverse outcomes for both mother and fetus. Shoulder dystocia during delivery and related permanent brachial plexus injury may be seen. Both neonatal mortality and morbidity are higher in macrosomic fetuses compared with normal weight fetuses. The rate of meconium aspiration and the need for mechanical ventilatory support are increased in this group of neonates. Maternal complications such as postpartum hemorrhage, infections, as well as third- or fourth-degree vaginal lacerations may occur as a result of operative delivery.
Therefore, for the prevention of traumatic birth and adverse outcomes, many studies have been performed for predicting birth weight accurately. Through the accurate prediction of macrosomic fetuses that have risk of traumatic birth, the route of delivery may be changed. Ultrasound-based birth weight prediction is still insufficient. Investigators have attempted to improve ultrasound-based prediction of fetal macrosomia by various methods, such as the assessment of fat deposition at different locations. None of these methods have gained wide popularity because of the inability to accurately estimate fetal weight against conventional biometric formulas.
Studies that have assessed umbilical cord components to predict fetal weight have shown that there is a correlation between umbilical cord diameter, area and fetal biometric parameters. Also, some observers have suggested that combination of these two methods should give more reliable results for estimating macrosomic fetuses.
The aim of this work was to predict fetal macrosomia by measuring; HbA1c level, umbilical cord thickness and Interventricular septum thickness.
This study was a case control study, which was carried out at Obstetrics and Gynecology outpatient clinic at Beni-Suef University Hospital and 6th October University hospital. The study was conducted on 60 pregnant females that were divided into:
• (Study group): 30 with gestational diabetes mellitus.
• (Control group): 30 healthy controls.
The main results of the study revealed that:
There was no statistically significant difference between the studied groups as regard Age, Parity, Number of previous abortions or Gestational age.
There was statistically significant difference between the studied groups as regard Umbilical cord diameter.
There was statistically significant difference between the studied groups as regard Umbilical artery diameter.
There was statistically significant difference between the studied groups as regard Umbilical vein diameter.
There was high statistically significant difference between the studied groups as regard Wharton Jelly area.
There was high statistically significant difference between the studied groups as regard IVS diameter.
There was high statistically significant difference between the studied groups as regard HbA1c.
There was high statistically significant difference between the studied groups as regard birth weight.
There was high statistically significant difference between the studied groups as Macrosomic.
There was no statistically significant difference between the studied groups as regard Age, Gestational age.
Based on our findings, we recommend for further studies on larger sample size and on large geographical scale o emphasize our conclusion.