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Macrosomia fetal symptoms
Typical symptoms: Pregnant women often have heavy abdomen, abdominal pain, dyspnea, etc., accompanied by rapid weight gain.
Related symptoms: stomachache, abdominal pain of pregnant women without pregnancy, recessive postpartum hemorrhage
1. Clinical measurements
Uterine fundus height and abdominal circumference are the indexes of routine clinical detection, which are widely used in clinic because of their simple methods. According to uterine height and abdominal circumference to calculate the newborn birth weight of many formulas, but the accuracy is not ideal, can be used for preliminary diagnosis. According to the height of uterine fundus and abdominal circumference, there are great clinical errors in calculating the birth weight of newborns and diagnosing macrosomia, which are influenced by factors such as obesity, height and amniotic fluid volume of pregnant women. Here are only simple calculation methods.
Zeng Zhi et al. 's formula for calculating fetal weight according to uterine height and abdominal circumference
Formula 1: Fetal weight = (uterine height-n) × 150. When the fetus is exposed below the plane of ischial spine, n=11; When the fetal presentation is 0 to-1, n=12; When the fetal presentation is above-2, n=13.
Formula 2: Fetal weight = uterine height × abdominal circumference 150.
The results of 168 cases showed that 63% and 51% of the estimated weight errors in formula (1) and formula (2) were less than 100g, respectively.
The formula put forward by Yuan Dongsheng is as follows:
Formula 3: Fetal weight = uterine height × abdominal circumference 200.
Formula 4: Fetal weight = uterine height × uterine width × 4.5. In 1996, Luo Laimin et al. applied two steps to judge macrosomia. The first step was to calculate the product of uterine height and abdominal circumference. When uterine height × abdominal circumference > 3700, the following regression formula was used to calculate fetal weight:
Formula 5: Fetal weight = 2900 uterine height × abdominal circumference. According to this formula, the coincidence rate of macrosomia is 78%, the standard deviation is 250g, and the accuracy is higher than other indexes.
2. Ultrasonic measurements
Many scholars estimate the birth weight of newborns according to the fetal diameter examined by ultrasound. The commonly used diameters are fetal biparietal diameter (BPD) or fetal head circumference (HC), breast diameter (TD) or chest circumference (TC), abdominal diameter (AD) or abdominal circumference (AC), femoral length (FL) and so on. There are many methods to calculate fetal weight, but the accuracy is about 10%. Especially when the fetus is too large or too small, the prediction error is larger.
The earliest ultrasonic index used to predict fetal weight is BPD. Zhuo Jingru (1980) examined the biparietal diameter of 374 pregnant women. When BDP was 10cm, the birth weight of newborns was 3925g 323g, 4000g when BDP was 10.2 cm, and 4290g when BDP was 10.4 cm.
With the development and popularization of computer technology, the formula for predicting fetal weight is becoming more and more complex. The basic point of predicting fetal weight when applying multiple ultrasound examination indexes together. The joint prediction formula put forward in the early stage and widely circulated is Shephard's formula for predicting newborn birth weight by using BPD and AC in 1982:
Formula 6: log10 (BW) =-1.7492 0.166 × BPD 0.046 × AC-2. 646 × ACxBPD/1000. The birth weight of newborns at BW is g, log10 is the logarithm based on 10, and BPD and AC are centimeters (CM). Therefore, Hadlock proposed a calculation formula for predicting fetal weight by using TC, AC and FL:
Formula 7: log10 (BW) = 1.5662-0.0108 (TC) 0.0468 (AC) 0.171 (FL) 0.00034 (TD) 2-0.003685 (AC × FL) Where BW is in grams (g) and TC, AC and FL are in centimeters (CM).
Most of the formulas for predicting fetal weight are obtained by statistical multiple regression method, and the deviation is large when predicting macrosomia fetal weight. In addition, there are many other calculation methods. DuBose et al. put forward the method of calculating fetal volume, and Li Xiaotian et al. of Obstetrics and Gynecology Hospital of Fudan University used artificial neural network to predict fetal weight. Luo Laimin et al. reported that 90% of fetuses with biparietal diameter > 10cm were macrosomia. Therefore, the biparietal diameter of fetus examined by ultrasound has great reference value in predicting macrosomia.
AC and FL also play an important role in predicting fetal weight. AC may be a relatively accurate index for predicting macrosomia among single indexes. Menon (1990) and Keller (1990) systematically monitored fetal AC at the 20th week of pregnancy. If the increase of AC was greater than the average, the incidence of macrosomia increased. FL is an index of fetal long bone development. FL is linearly correlated with fetal gluteal parietal diameter, which plays a unique role in predicting fetal weight. Combined with other indexes, the accuracy of prediction can be improved. According to the literature reports in recent 10 years, the sensitivity and specificity of predicting macrosomia are only 60% and 90% respectively. In 1996, Adashek and others thought that according to the current method to predict fetal weight, when the predicted value > 400At 0g, the rate of cesarean section increased significantly regardless of whether the newborn was actually macrosomia.
Therefore, the advantages of the method of predicting fetal weight based on the fetal diameter of ultrasound examination have not been proved at present, but the data of ultrasound examination can provide reference for clinical obstetricians. Clinical diagnosis of fetal macrosomia should be based on clinical history, abdominal examination, fundus height and abdominal circumference, and fetal diameter measured by ultrasound, comprehensive analysis and clinical experience.
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