Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
J Perinat Med. 2012 Apr 22;40(5):483-8. doi: 10.1515/jpm-2011-0306.
To determine whether a customized standard for large for gestational age (LGA) identifies undiagnosed women at risk of operative delivery and shoulder dystocia.
We previously generated customized standards from our institution. We compared the baseline maternal characteristics and neonatal outcomes between LGA and non-LGA births, which were classified by both population-based and customized standards. The risk of operative delivery (vacuum delivery or emergent cesarean section) and shoulder dystocia was compared by logistic regression analysis in LGA pregnancies that were identified by a population-based birth weight standard and a customized standard after adjusting for maternal age, parity, body mass index, and neonatal gender.
Multivariable analysis revealed that the pregnancies identified as LGA by a customized standard were associated with an increased risk of emergent cesarean section [odds ratio (OR), 4.09; 95% confidence interval (CI), 3.00-5.74] and shoulder dystocia (OR, 10.56; 95% CI, 5.52-20.19). However, there was no association between an increased risk of vacuum delivery (OR, 1.45; 95% CI, 0.92-2.30) and pregnancies identified as non-LGA, using both standards. In addition, customized LGA infants were at increased risk of admission to neonatal intensive care unit (OR 1.63; 95% CI, 1.09-2.43).
A customized standard of LGA is useful in identifying previously unrecognized women at risk of emergent cesarean section and shoulder dystocia.
确定用于巨大儿（LGA）的定制标准是否可以识别未被诊断为有手术分娩和肩难产风险的女性。
我们之前从我们的机构中生成了定制标准。我们比较了基于人群的和定制标准分类的 LGA 和非 LGA 分娩的基线产妇特征和新生儿结局。通过逻辑回归分析，比较了通过基于人群的出生体重标准和定制标准识别的 LGA 妊娠中手术分娩（真空分娩或紧急剖宫产）和肩难产的风险，调整了产妇年龄、产次、体重指数和新生儿性别等因素。
多变量分析显示，通过定制标准识别为 LGA 的妊娠与紧急剖宫产（优势比 [OR]，4.09；95%置信区间 [CI]，3.00-5.74）和肩难产（OR，10.56；95% CI，5.52-20.19）的风险增加有关。然而，使用这两种标准，将妊娠识别为非 LGA 与增加真空分娩的风险（OR，1.45；95% CI，0.92-2.30）之间没有关联。此外，定制的 LGA 婴儿入住新生儿重症监护病房的风险增加（OR 1.63；95% CI，1.09-2.43）。
LGA 的定制标准可用于识别以前未被识别的有紧急剖宫产和肩难产风险的女性。
