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An Assessment of Pregnancies Complicated by Macrosomia
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26-128-1
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An Assessment of Pregnancies Complicated by Macrosomia
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Dr. Elizabeth Morgan
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The term "macrosomia" is used to describe infants that are at or above a birth weight considered excessive. This threshold birth weight is typically set at more than 4,000 or 5,000 grams. Excessive fetal growth is a concern for both the obstetrician and the patient because as birth weight increases the risk of delivery complications increase for both the infant and mother. Neonatal complications of macrosomia include shoulder dystocia with brachial plexus injury, depressed APGAR scores, hypoglycemia, and admission to the neonatal intensive care unit (7). Complications increase with increasing birth weight. A study of 175,886 vaginal deliveries in California documented an odds ratio for shoulder dystocia of 3.542 for birth weight of 4000-4500 grams and 10.122 for birth weight greater than 4500 grams. Infants weighing greater than 5000 grams were twice as likely to die than those with a normal weight (3000-3999 grams) (2). Maternal complications known to be the result of delivering a macrosomic infant include postpartum hemorrhage, third or fourth degree lacerations, risk of cesarean delivery after protracted labor and arrest disorders, and chorioamnionitis (7). Patients diagnosed with suspected macrosomia by ultrasound have an increased cesarean delivery rate for labor arrest noting that ultrasound estimation or over estimation may lead to a lower threshold to call for cesarean delivery (8). Another study documented that patients that were diagnosed prenatally with macrosomia had 3.5 times the risk of cesarean delivery compared to those that were not diagnosed prior to delivery (9). The risks of postpartum hemorrhage, prolonged labor and cesarean delivery all increased with increasing macromia; 4000-4499, 4500-4999, and >5000 (2). Reported risk factors for having a macrosomic infant include history of macrosomic infant, post-term pregnancy, maternal prepregnancy obesity, excessive gestational weight gain, and preexisting and gestational diabetes (GDM) (3,4). We seek to examine the trends in the delivery of macrosomic infants at UConn Health, Hartford Hospital, St. Francis Hospital and Medical Center, including yearly rate of macrosomic infants delivered and the complications associated with these deliveries. We will also attempt to determine risk factors for excessive infant growth in order to look for interventions that could improve outcomes. Our primary objective is to examine the trends in the delivery of macrosomic infants at UConn Health Center, Hartford Hospital and St. Francis Hospital and Medical Center, and including yearly rate of macrosomic infants delivered and the complications associated with these deliveries. We will also attempt to determine risk factors for excessive infant growth to look for interventions that could improve outcomes. Data collected will include newborn data of infants cared for in the respective postpartum/nursery units, hospital neonatal intensive care units (NICU) and Connecticut Children's Medical Center NICU. We hypothesize that there has been an increase in the rate of macrosomic infant deliveries at UConn Health Center, Hartford Hospital, and St. Francis Hospital and Medical Center since 2018. This could be due to an increase in excessive gestational weight gain and gestational and pre-gestational diabetes.
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Obstetrics and Gynecology
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Women’s Health (Infertility, Menopause, Etc.)
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Check with study contact
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Jeannine Whelan. Telephone: Not Available. Email: jewhelan@uchc.edu or Kasey McKenna. Telephone: Not Available. Email: kamckenna@uchc.edu or Poorna Balakumar. Telephone: Not Available. Email: balakumar@uchc.edu
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Enrolling/recruiting. For current recruitment status, please check with study contact.
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