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Master thesis

Evaluation des méthodes de dépistage de la macrosomie foetale par l'échographie du 3ème trimestre et ses conséquences sur la prise en charge obstétricales et la santé des nouveau-nés dans la cohorte EDEN à Nancy

Abstract : Introduction : Fetal macrosomia is associated with maternal and fetal morbidity.Sonographic prediction of macrosomia is currently used but its performance is quite poor. So it is important to question about its usefulness.Objectives : Evaluate the diagnosis of macrosomia and its consequences on perinatal outcomes.Methods : We retrospectively included 962 women from the prospective cohort EDEN with a third trimester ultrasound examination. First we evaluated how performant we were to predict macrosomia by sonographic measurement of BPD, HC, AC and LF, by sonographic EFW and by clinical fundal height measurement at the third trimester. Then we determined if the sonographic diagnosis of macrosomia defined by AC ? 90e percentile altered the management of labor and delivery and newborns' health. Results : The diagnosis of macrosomia is not very efficient, wichever the technique we use. For the AC ?90th percentile, sensitivity is 64,7%, specificity 74,9% and positive predictive value 12,6%. Other sonographic measures are less efficient. EFW by Hadlock's equation has a better positive predictive value but is less sensitive than AC. The diagnosis of macrosomia did not alter obstetrical management. We did not observe more induction of labor (23% vs 22%, p=0,74 ; OR 1,06 [0,76-1,49]) or cesarean section (16,9% vs 19,7%, p=0,34 ; OR 0,83 [0,57-1,21]) when fetal macrosomia was suspected. We didn't notice a reduction of neonatal morbidity of newborns weighting 4000 g or more when macrosomia was suspected at antenatal period. We did not notice as well iatrogenic effects of a diagnosis of macrosomia in normal weight newborns. Conclusion : The diagnostis of macrosomia is not proved to be efficient. It doesn't improve newborns' health even if, in our study, it does not appear to be iatrogenic. So we may use it with caution in obstetrical management
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Anabela Janela. Evaluation des méthodes de dépistage de la macrosomie foetale par l'échographie du 3ème trimestre et ses conséquences sur la prise en charge obstétricales et la santé des nouveau-nés dans la cohorte EDEN à Nancy. Sciences du Vivant [q-bio]. 2010. ⟨hal-01734159⟩

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