Sonographic Umbilical Cord Parameters in Third Trimester of Pregnancy with Gestational Diabetes Mellitus as Predictors of Macrosomia
Divya Pandey, Suvrata Garg, Rekha Bharti, Pratima Mittal, Jyotsna Suri
Adverse perinatal outcome, Body mass index, Shoulder dystocia prediction, Third trimester, Third trimester scan, Ultrasonography, Umbilical cord
Citation Information :
Pandey D, Garg S, Bharti R, Mittal P, Suri J. Sonographic Umbilical Cord Parameters in Third Trimester of Pregnancy with Gestational Diabetes Mellitus as Predictors of Macrosomia. J South Asian Feder Obs Gynae 2022; 14 (3):265-270.
Background: Gestational diabetes mellitus (GDM) is associated with various complications. Macrosomia is one such complication.
Aim: To predict fetal macrosomia by sonographic measurements of umbilical cord thickness (CT) and cross-sectional area (CSA) in GDM in third-trimester.
Method: This prospective-cohort-observational study on 40 antenatal women with GDM (group I) over a period of 12 months at a tertiary teaching institute against 40 antenatal women without GDM or any medical co-morbidity (group II). Cord parameters [CT (cm) and CSA (cm2)] were assessed sonographically after 36 weeks. Pregnancy outcomes were noted. CT/CSA value more than 90th centile taken as cut-off value was considered as large cord. The predictive accuracy of the cut-off of cord parameters to predict macrosomia was calculated.
Results: The mean age and BMI of women under study were 27.9 ± 2.84 years and 26.05 ± 1.32 kg/m2. The cut-off of large cords was 2.8 cm and 3.56 cm2 for CT and CSA, respectively. Large cords were found in 70% of the study group. Sonographically detected umbilical-cord parameters were significantly larger in macrosomic fetuses as compared to nonmacrosomic fetuses macrosomia was found in 17.5% cases of study group. The sensitivity, specificity, positive predictive value, and negative predictive value of cord parameters to predict macrosomia were 57.1, 96.9, 80, and 91.4% for CT and 65.7, 63.6, 46.2, and 87.5% for CSA, respectively.
Conclusion: Sonographically detected umbilical CT and CSA are good predictors of fetal macrosomia with high negative predictive value.
Clinical significance: Cord is an easily accessible and assessable organ requiring minimal expertise for sonographic assessment compared to other available parameters. Thus, it can be used as an easy option to predict macrosomia along with other predictors.
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