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Master Thesis

Pertinence d’un contrôle systématique de la glycémie et de la calcémie chez les nouveau-nés macrosomes : étude de cohorte sur un échantillon de 204 enfants classés comme macrosomes nés entre le 24 juin 2015 et 24 juillet 2016 au CHU de Grenoble

Abstract : Objectives : Evaluate the relevance of the current guidelines concerning the risk of hypoglycaemia and hypocalcaemia in newborns with foetal macrosomia at the Hospital of Grenoble. The secondary objectives were to further classify the macrosomia as asymmetric or symmetric. Method : We conducted an analytical, non-controlled cohort study, in the Central Hospital of Grenoble, Maternity Level 3. We collected the data retrospectively from the 24th of June 2015 to the 24th of July 2016. Newborns were diagnosed with foetal macrosomia by a midwife thanks to the use of the AUDIPOG curve after the birth. Then, newborns were further classified as asymmetric or symmetric using their ponderal index. The result measured was the number of newborns, identified as macrosomia newborns, who presented with clinical and/or biological signs linked to the macrosomia. Results : 204 macrosomia newborns were included in our study. Among these newborns, 12,2% presented with hypoglycaemia at 1 hour of life and 3,3% post natal. The hypocalcaemia frequency was 3,9%. In total, 16,3% of the included macrosomia newborns presented with at least one pathological value or a clinical sign postnatally. The main complication seen was hypoglycaemia during the first post natal hours. Our study did not find a statistical difference between neonatal complications, maternal characteristics and obstetrical complications in asymmetric and symmetric macrosomia newborns. We found a significant increase of post partum haemorrhage compared to the national average (8% versus 3%), 1 in 10 vaginal deliveries had complications involving difficulties or a dystocia passing the shoulders. Conclusion : Our study calls into question the medical and economic relevance of the current guidelines for foetal macrosomia and highlights the difference in the maternal and foetal characteristics and the associated complications between the general population and macrosomia newborns. Our study recommends the implementation of systematic glycaemic testing at 1 hour of life as well as further research into alternatives for the prevention of hypoglycaemia and hypocalcaemia in newborns. Reconsideration of the current classifications of macrosomia would also be pertinent. In view of our results, our study does not recommend the use of the Ponderal Index, however further investigation into this area would be valuable. Finally, our study serves as a reminder to all midwives of the warning signs and appropriate actions required prior to the mother’s delivery when a foetal macrosomia is suspected.
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https://dumas.ccsd.cnrs.fr/dumas-01560902
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Submitted on : Wednesday, July 12, 2017 - 10:25:23 AM
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  • HAL Id : dumas-01560902, version 1

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Diane Johnson. Pertinence d’un contrôle systématique de la glycémie et de la calcémie chez les nouveau-nés macrosomes : étude de cohorte sur un échantillon de 204 enfants classés comme macrosomes nés entre le 24 juin 2015 et 24 juillet 2016 au CHU de Grenoble. Gynécologie et obstétrique. 2017. ⟨dumas-01560902⟩

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