Objectives. To evaluate the utility of fetal abdominal wall thickness (AWT) for predicting intrapartum complications amongst mothers with pregestational type 2 diabetes. Methods. This was a historical cohort study of pregnant mothers with pregestational type 2 diabetes delivering at a Canadian tertiary-care center between January 1, 2014, and December 31, 2018. Delivery records were reviewed to collect information about demographics and peripartum complications. Stored fetal ultrasound images from 36 weeks’ gestation were reviewed to collect fetal biometry and postprocessing measurement of AWT performed in a standardized fashion by 2 blinded and independent observers. The relationship between fetal AWT was then correlated with risk of intrapartum complications including emergency Caesarean section (CS) and shoulder dystocia. Results. 216 pregnant women with type 2 diabetes had planned vaginal deliveries and were eligible for inclusion. Mean maternal age was 31.3 years, and almost all were overweight or obese at the time of delivery (96.8%). Overall, the incidence of shoulder dystocia and emergency intrapartum CS was 7.4% and 17.6%, respectively. There was no difference in mean fetal AWT between those having a spontaneous vaginal delivery (8.2 mm (95% CI 7.9-8.5)) and those needing emergency intrapartum CS (8.1 mm (95% CI 7.4-8.8); ) or shoulder dystocia (8.7 mm (95% CI 7.9-9.5); ). There was strong interobserver correlation of AWT measurements (; ). The strongest association with intrapartum complications was birthweight (): with grams, the relative risk of shoulder dystocia or CS is 2.75 (95% CI 1.74-4.36; ). Conclusions. There was no obvious benefit of AWT measurement at 36 weeks for predicting shoulder dystocia or intrapartum CS amongst women with type 2 diabetes in our population. The strongest predictor of intrapartum complications remained birthweight, and so studies for improving estimation of fetal weight and evaluating the role of intrapartum ultrasound for predicting risk of delivery complications are still needed.

中文翻译：

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孕前2型糖尿病母亲胎儿腹壁厚度与产时并发症的关系

目标。评估胎儿腹壁厚度 (AWT) 在预测妊娠前 2 型糖尿病母亲产时并发症中的效用。方法. 这是一项历史队列研究，对象为 2014 年 1 月 1 日至 2018 年 12 月 31 日期间在加拿大三级保健中心分娩的孕前 2 型糖尿病孕妇。审查分娩记录以收集有关人口统计和围产期并发症的信息。对存储的妊娠 36 周的胎儿超声图像进行审查，以收集胎儿生物测定和 AWT 的后处理测量，由 2 位盲法和独立观察者以标准化方式进行。胎儿 AWT 与产时并发症的风险相关，包括紧急剖腹产 (CS) 和肩难产。结果. 216 名患有 2 型糖尿病的孕妇计划进行阴道分娩并符合入选条件。产妇平均年龄为 31.3 岁，几乎所有产妇在分娩时都超重或肥胖（96.8%）。总体而言，肩难产和紧急产时 CS 的发生率分别为 7.4% 和 17.6%。自发性阴道分娩 (8.2 mm (95% CI 7.9-8.5)) 和需要紧急产时 CS (8.1 mm (95% CI 7.4-8.8) 的孕妇的平均胎儿 AWT 没有差异；)或肩难产 (8.7 mm (95% CI 7.9-9.5);）。AWT测量的观察者间相关性很强（; ）。与产时并发症最相关的是出生体重（):与 克，肩难产或 CS 的相对风险为 2.75（95% CI 1.74-4.36； ）。 结论。在我们人群中的 2 型糖尿病女性中，36 周时 AWT 测量对于预测肩难产或产时 CS 没有明显益处。产时并发症的最强预测因素仍然是出生体重，因此仍然需要研究改进胎儿体重的估计和评估产时超声在预测分娩并发症风险方面的作用。