الفهرس 
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Abstract
Introduction:
Fetal macrosomia is defined as a birth weight of 4000 gm or higher, and is associated with increased maternal and neonatal morbidity (Johnstone et al., 1996); Based on these definitions, macrosomia affects 1-10% of all pregnancies.
Many efforts have been dedicated to evaluate the accuracy with which clinical or ultrasonographic methods can predict birth weight.
The majority of studies on prediction of macrosomia are based on sonographic measurements employed as either single parameters (such as abdominal circumference or subcutaneous tissue thickness) or combinations of measures to estimate fetal weight. The different sonographic methods do not seem to differ substantially in terms of power to predict macrosomia ( Chauhan et al., 2000).
However, the single ultrasonographic measurement which correlates most strongly with birth weight is fetal abdominal circumference (FAC), and this is widely used as a single measurement of fetal size (Smith et al., 1990).
Macrosomia has many complications which can be associated with maternal and fetal morbidity; birth trauma and perinatal asphyxia are increased in patients with fetal macrosomia, who are vaginally delivered (Spellacy et al., 1985).
Shoulder dystocia, one of the worst obstetric emergencies, occurs in 0.15-1.7% of vaginal deliveries. About half of shoulder dystocia happen to macrosomic infants (birth weight of 4000 g or more) (Cunningham et al., 1993).
Macrosomia is associated with many adverse outcomes, for example, prolonged labor, premature labor, increase risk of traumatic damage, increase risk of shoulder dystocia, increase risk of cesarean section, fetal distress, birth asphyxia, brachial plexus injury, stillbirth, cephalhaematoma, etc (Acker et al., 1985).
The majority of studies on prediction of macrosomia are based on sonographic measurements employed as either single parameters (such as abdominal circumference or subcutaneous tissue thickness) or combinations of measures to estimate fetal weight. The different sonographic methods do not seem to differ substantially in terms of power to predict macrosomia (O’Reilly-Green et al., 2000).
However, the single ultrasonographic measurement which correlates most strongly with birth weight is fetal abdominal circumference (FAC), and this is widely used as a single measurement of fetal size (Smith et al., 1990).
Aim of the work:
In the present study our aim is to diagnose fetal macrosomia using a single U/S parameter which is fetal abdominal circumference (FAC), to evaluate the effect of FAC on outcome of labor and to find out a cut-off value of FAC to anticipate dysfunctional labor.
Patients and methods:
This study included 100 pregnant women, who were admitted for labor to the delivery ward of ” Beni-Seuf University Hospital”.
The women included in this study had no medical disorders except D.M and had singleton pregnancies without major anomalies as indicated by ultrasound examination.
Women with previous uterine scar or pregnancy related complications were excluded from this study.
Included women were examined abdominally and locally. Trans-abdominal ultrasound was performed to all included women, for measuring FAC, and ultrasonically estimated fetal weight, then the partogram is set up and the patient is followed up according to her spontaneous progression in partogram and mode of delivery and birthweight were noted.
Result:
When FAC is measured ≥ 372.5 mm, the patient should be closely monitored through a carefully plotted partogram, as those are more likely for delayed progress of labor and delivery by CS.
Conclusion:
1- Measurement of FAC is a good predictor in estimation of fetal weight.
2- Fetal macrosomia (4000 gm or higher) can be diagnosed accurately by sonographic measurement when FAC is measured ≥ 372.5 mm
3- Not all macrosomic fetuses are accompanied by complication in labor because assessment of progress of labor is done carefully through partogram.
4- Mode of delivery not depends on fetal weight or FAC but depends on cephalo-pelvic proportion (CPP) and progress of labor which is assessed partogram carefully.
5- Through our study we found that the incidence of macrosomia in general population is about 8%.
Recommendation:
1- We can use FAC only to evaluate macrosomic fetuses when fetal weight (4000 gm or higher) and this is a warning sign for the obstetrician for good assessment of progress of labor and partogram.
2- Partogram is mandatory for assessment of progress of any labor.
3- Further studies must be conducted on a large number of suspected macrosomic fetuses to get more accurate cut-off value to FAC.