title: Large cross-sectional area of the umbilical cord as a predictor of fetal macrosomia.
abstract: OBJECTIVE
  To determine whether a large cross-sectional area of the umbilical cord is a predictor of fetal macrosomia.
  
  
  METHODS
  Consecutive patients of > 34 weeks' gestation, who presented for sonographic examination and who delivered within 4 weeks of the examination, were included in the study. The sonographic cross-sectional areas of the umbilical cord, the umbilical vessels and the Wharton's jelly were measured in a free loop of the umbilical cord. Logistic regression analysis was used to determine significant predictors of macrosomia (actual birth weight > 4000 g and > 4500 g). Fetal biometric parameters (biparietal diameter, abdominal circumference and femur length), sonographic estimated fetal weight and umbilical cord area > 95(th) centile for gestational age were used as covariates.
  
  
  RESULTS
  During the study period, 1026 patients were enrolled. Fifty-three (5.2%) newborns had a birth weight > 4000 g, and 22 (2.1%) weighed > 4500 g. The proportion of cases with a large umbilical cord was significantly higher in the group of macrosomic compared with non-macrosomic infants (54.7% vs. 8.7%, P < 0.0001). Multiple regression models demonstrated an independent contribution of the large cord in the prediction of birth weight > 4000 g and > 4500 g (odds ratio (95% CI), 20.6 (9.2-45.9) and 4.2 (1.2-17.7), respectively). The sensitivity, specificity and positive and negative predictive values of a sonographic large umbilical cord were 54.7%, 91.3%, 25.4%, and 97.4%, respectively. The combination of abdominal circumference > 95(th) centile and large cord predicted 100% of macrosomic infants. The proportion of umbilical cords with a Wharton's jelly area > 95(th) centile for gestation was significantly higher in macrosomic fetuses of diabetic compared with non-diabetic mothers.
  
  
  CONCLUSIONS
  Sonographic assessment of umbilical cord area may improve the prediction of fetal macrosomia.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. antonellacromi@libero.it
authors.forename: A
authors.initials: A
authors.lastname: Cromi
authors.forename: F
authors.initials: F
authors.lastname: Ghezzi
authors.forename: E
authors.initials: E
authors.lastname: Di Naro
authors.forename: G
authors.initials: G
authors.lastname: Siesto
authors.forename: V
authors.initials: V
authors.lastname: Bergamini
authors.forename: L
authors.initials: L
authors.lastname: Raio
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D016640:Diabetes, Gestational; D005260:Female; D005320:Fetal Macrosomia / Q000000981:diagnostic imaging*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011254:Pregnancy in Diabetics; D018566:Pregnancy, High-Risk; D014463:Ultrasonography; D014470:Umbilical Cord / Q000000981:diagnostic imaging* / Q000473:pathology