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Master Thesis

Issues obstétricales des fœtus macrosomes à l’échographie du 3ème trimestre

Abstract : Objectives: to experiment if the EFW ≥ 90th percentile at the routine third trimester scan is associated with adverse obstetrics outcomes, and second to determine which, if any, ultrasound markers of excessive foetal growth could identify patients at risk. Methods: this was a single-centre retrospective cohort study. The study population included 857 consecutive single pregnancies who underwent routine third trimester ultrasound examination from 2013 to 2016. 86 patients (10%) delivered neonates ≥ 90th percentile and 771 (90%) were unaffected cases. Results: area under the receiver operating characteristic curves for screening for a LGA using the ultrasound EFW was 0.84 (95% CI 0.79-0.88), whereas it was 0.81 (0.77-0.86) for the abdominal circumference. There was no evidence for association between an EFW < 90th or EFW ≥ 90th percentile and the risk of adverse neonatal outcomes. There was no difference in rates of caesarean delivery (17% in the control group vs 29% in the LGA fetus group; P = 0.11), operative vaginal delivery (10% vs 3% respectively; P = 0.35), shoulder dystocia (2% vs 0% respectively, P > 0.99), the need of episiotomy, 3rd and 4th degree perineal tears nor post-partum haemorrhage in the two groups. The multivariable regression analysis demonstrated that a significant contribution to the prediction of caesarean delivery was provided by AC measured ≥ 90th percentile (Adjusted OR 3.4; 95% CI 1.9-6.2). Conclusion: we may reassure patients, and the medical team about LGA foetus at the third trimester ultrasound examination. Nevertheless, AC ≥ 90th percentile is linked to unplanned caesarean sections, mostly for arrest of descent. These patients could be better candidates for an additional ultrasound at around 36 weeks.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01978683
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Friday, January 11, 2019 - 4:34:31 PM
Last modification on : Saturday, February 9, 2019 - 1:18:12 AM

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Marie Gravelle. Issues obstétricales des fœtus macrosomes à l’échographie du 3ème trimestre. Médecine humaine et pathologie. 2018. ⟨dumas-01978683⟩

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