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Hehir MP, Burke N, Burke G, Turner MJ, Breathnach FM, Mcauliffe FM, Morrison JJ, Dornan S, Higgins J, Cotter A, Geary MP, Mcparland P, Daly S, Cody F, Dicker P, Tully E, Malone FD. Sonographic markers of fetal adiposity and risk of Cesarean delivery. Ultrasound Obstet Gynecol 2019; 54:338-343. [PMID: 30887629 DOI: 10.1002/uog.20263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Increased fetal size is associated with shoulder dystocia during labor and subsequent need for assisted delivery. We sought to investigate if increased fetal adiposity diagnosed sonographically in late pregnancy is associated with increased risk of operative delivery. METHODS This secondary analysis of the Genesis Study recruited 2392 nulliparous women with singleton pregnancy in cephalic presentation, in a prospective, multicenter study, to examine prenatal and intrapartum predictors of Cesarean delivery. Participants underwent ultrasound and clinical evaluation between 39 + 0 and 40 + 6 weeks' gestation. Data on fetal biometry were not revealed to patients or to their managing clinicians. A fetal adiposity composite of fetal thigh adiposity and fetal abdominal wall thickness was compiled for each infant in order to determine whether fetal adiposity > 90th centile was associated with an increased risk of Cesarean or operative vaginal delivery. RESULTS After exclusions, data were available for 2330 patients. Patients with a fetal adiposity composite > 90th centile had a higher maternal body mass index (BMI) (25 ± 5 kg/m2 vs 24 ± 4 kg/m2 ; P = 0.005), birth weight (3872 ± 417 g vs 3585 ± 401 g; P < 0.0001) and rate of induction of labor (47% (108/232) vs 40% (834/2098); P = 0.048) than did those with an adiposity composite ≤ 90th centile. Fetuses with adiposity composite > 90th centile were more likely to require Cesarean delivery than were those with adiposity composite ≤ 90th centile (P < 0.0001). After adjusting for birth weight, maternal BMI and need for induction of labor, fetal adiposity > 90th centile remained a risk factor for Cesarean delivery (P < 0.0001). A fetal adiposity composite > 90th centile was more predictive of the need for unplanned Cesarean delivery than was an estimated fetal weight > 90th centile (odds ratio, 2.20 (95% CI, 1.65-2.94; P < 0.001) vs 1.74 (95% CI, 1.29-2.35; P < 0.001). Having an adiposity composite > 90th centile was not associated with an increased likelihood of operative vaginal delivery when compared with having an adiposity composite ≤ 90th centile (P = 0.37). CONCLUSIONS Fetuses with increased adipose deposition are more likely to require Cesarean delivery than are those without increased adiposity. Consideration should, therefore, be given to adding fetal thigh adiposity and abdominal wall thickness to fetal sonographic assessment in late pregnancy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M P Hehir
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - N Burke
- Rotunda Hospital, Dublin, Ireland
| | - G Burke
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M J Turner
- University College Dublin Centre for Human Reproduction, School of Medicine and Medical Science, Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F M Breathnach
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
| | - F M Mcauliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - J J Morrison
- Department of Obstetrics and Gynaecology, National University of Ireland, Galway, Ireland
| | - S Dornan
- Royal Jubilee Maternity Hospital, Belfast, Ireland
| | - J Higgins
- University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - A Cotter
- Department of Obstetrics and Gynaecology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | | | - P Mcparland
- National Maternity Hospital, Dublin, Ireland
| | - S Daly
- Coombe Women and Infants Maternity Hospital, Dublin, Ireland
| | - F Cody
- Rotunda Hospital, Dublin, Ireland
| | - P Dicker
- Epidemiology & Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Tully
- Rotunda Hospital, Dublin, Ireland
| | - F D Malone
- Royal College of Surgeons in Ireland, Rotunda Hospital, Dublin, Ireland
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Crosby DA, Delau D, Brophy C, Mcauliffe FM, Mahony R. Uptake of the Influenza Vaccination in Pregnancy. Ir Med J 2016; 109:449. [PMID: 28124849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Influenza is caused by a highly infectious RNA virus, which usually occurs in a seasonal pattern with epidemics in the winter months. The objective of this study was to determine the uptake of the influenza vaccine in a pregnant population and ascertain the reasons why some women did not receive it. A prospective cohort study was conducted over a two-week period in January 2016 in the National Maternity Hospital Dublin, a tertiary referral maternity hospital delivering over 9000 infants per year. There were 504 women studied over the 2-week period. Overall, 197(39.1%) women received the vaccine at a mean gestational age 20.9 weeks (SD 7.0). Given the increased rates of influenza in the community and the associated implications for mother and infant, it is important that pregnant women are educated regarding the risks of influenza in pregnancy and encourage this cohort to be vaccinated.
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Affiliation(s)
- D A Crosby
- Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2
| | - D Delau
- Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2
| | - C Brophy
- Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2
| | - F M Mcauliffe
- Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2
| | - R Mahony
- Department of Obstetrics and Gynaecology, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2
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Mone F, Quigley J, Doyle B, Lambert M, Woolfson M, Downey P, Carroll S, Higgins S, Mahony R, Mcauliffe FM, Fitzgerald J, Mcparland P. Clinical disparity of haemolytic disease of the fetus and newborn in twin pregnancy. Transfus Med 2015; 25:345-6. [DOI: 10.1111/tme.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 07/15/2015] [Accepted: 07/16/2015] [Indexed: 11/30/2022]
Affiliation(s)
- F. Mone
- Department of Fetal Medicine; National Maternity Hospital; Dublin
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science; University College Dublin
| | - J. Quigley
- Department of Pathology and Laboratory Medicine; National Maternity Hospital; Dublin
| | - B. Doyle
- Irish Blood Transfusion Service; National Blood Centre; Dublin
| | - M. Lambert
- Irish Blood Transfusion Service; National Blood Centre; Dublin
| | - M. Woolfson
- Irish Blood Transfusion Service; National Blood Centre; Dublin
| | - P. Downey
- Department of Pathology and Laboratory Medicine; National Maternity Hospital; Dublin
| | - S. Carroll
- Department of Fetal Medicine; National Maternity Hospital; Dublin
| | - S. Higgins
- Department of Fetal Medicine; National Maternity Hospital; Dublin
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science; University College Dublin
| | - R. Mahony
- Department of Fetal Medicine; National Maternity Hospital; Dublin
| | - F. M. Mcauliffe
- Department of Fetal Medicine; National Maternity Hospital; Dublin
- UCD Obstetrics and Gynaecology, School of Medicine and Medical Science; University College Dublin
| | - J. Fitzgerald
- Department of Pathology and Laboratory Medicine; National Maternity Hospital; Dublin
| | - P. Mcparland
- Department of Fetal Medicine; National Maternity Hospital; Dublin
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