BPP combines data from two sources (ultrasound imaging and fetal heart rate monitoring). doi: https://doi.org/10.1016/j.ajog.2021.08.001. Fetal macrosomia is a description of excessive fetal size. 2015. No difference in perinatal mortality. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. Obstet Gynecol 2016;128:e195-209. We recruited 744 healthy women with singleton pregnancies. The new 8th Edition provides a single place to look for the most recent and most trustworthy recommendations on quality care of pregnant women, their fetuses, and their neonates. 1, 2 Commonly defined as a birth weight of 4000 g or higher, fetal macrosomia is associated with increased maternal and neonatal morbidity. . Introduction. Of the multiple formulas for estimating fetal weight, no single one is universally used. Study further showed that there was a significant association between MRI-EFW ≥ 95th and certain perinatal outcomes. 108.1 ). The term "fetal macrosomia" is used to describe a newborn who's much larger than average. Laboratory Studies A glucose tolerance test at 24-28 weeks of gestation screens for gestational diabetes, a known risk factor for macrosomia. Found inside – Page 920A fetus or newborn is considered small for gestational age (SGA) if its weight ... Fetal macrosomia is defined as EFW above the 90th percentile for GA or a ... For the following conditions, please follow the links for appropriate imaging: † Fetal Growth Restriction and Macrosomia see: OB-20: Fetal Growth Problems (FGR and Macrosomia) † History of late fetal death (greater than or equal to 20 weeks) See: OB-9.10: History of Stillbirth Disclaimer, National Library of Medicine CONCLUSION: Idiopathic polyhydramnios is associated with large-for-gestational-age fetuses and macrosomia independent of maternal diabetes. They kindly shared their personal experience and lessons learned over the years. This book is beneficial for all the professionals working in the prenatal diagnosis. 2018 Feb;26(1):32-41. Both fundal height measurements and Leopold maneuvers are commonly used to estimate fetal size, but both methods have poor sensitivity and specificity for macrosomia. More studies on the clinical use of magnetic resonance imaging in obstetrics are urgently needed. Prenatal estimation of fetal weight (EFW) began during the very early days of obstetric ultrasound. A retrospective cohort study of women undergoing indicated obstetric ultrasound examinations within 7 days of delivery was conducted. For a fixed false-positive rate of 5 %, MRI-EFW detected 80.0% whereas US-EFW detected 59.1% of birthweight ≥ 95th centile. of fetal weight by ultrasound is especially dif ficult in macrosomic fetuses. Ontology: Fetal Macrosomia (C0015938) Definition (NCI) A fetus exceeding 4500 grams. For a fixed false-positive rate of 10 %, MRI-EFW detected 92.4% whereas US-EFW detected 76.2 % of birthweight ≥ 95th centile. In contrast, fetal macrosomia describes a baby weighing more than 4,000 g (about 8 lbs., 12.75 oz. Women's empowerment and elective cesarean section for a single pregnancy: a population-based and multivariate study in Vietnam. 2 Studies of ultrasound for prediction of fetal size published during the 1990s generally showed no improvement over clinical techniques . It can occur in approximately 1-1.5% of pregnancies. Objective To determine if birth weights greater than 4000 g can be predicted by ultrasound measurements of abdominal circumferences. LGA refers to neonatal birth weight larger than the 90th percentile for a given gestational age. There was no apparent effect of maternal diabetes on the humeral soft tissue thickness. 2021 Jun 30;14:3049-3057. doi: 10.2147/IJGM.S313952. Unfortunately this algorithm is still relatively imprecise, identifying only 73% of LGA neonates > 95th centile for a fixed false positive rate of 10%. (2020) Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy. 2015 Jan;50(1):17-21. Fetal growth restriction; an estimated or actual weight of the fetus below 10th percentile for gestational age M-mode an ultrasound imaging technique in which structure movement can be depicted in a wave-like manner; primarily used in cardiac and fetal cardiac imaging macrosomia estimated fetal weight of greater than 4000 or 4500 grams PLoS Med. Ultrasound has been used for this purpose but for this approach to be effective, a clear definition of macrosomia, selection of the appropriate parameters for measurement and specification of the optimal time for carrying out the ultrasound studies are . Macrosomia is a risk factor for adverse perinatal outcomes and so far, traditional screening methods have been relatively poor in terms of performance. Some also use an increased birth weight (i.e. The information from diagnostic obstetric imaging can be used to assess fetal well-being in at-risk pregnancy and to facilitate invasive procedures such as amniocentesis. Accessibility Would you like email updates of new search results? This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. 173. PURPOSE: To determine the relationship between idiopathic polyhydramnios and fetal macrosomia in the absence of maternal diabetes. Other important risk factors are multiparity, prior macrosomic infants, male sex, ethnicity, maternal birth weight greater than 4000 g, and advanced maternal age. LGA is defined as fetal weight above the 90th percentile for the baby's gestational age, based upon growth curves generated from national statistics. The normal range (mean +/- 2 SD) in the 105 normal-weight fetuses was 22.0 +/- 2, while the normal range in the 51 macrosomic fetuses was 20.5 +/- 2; these differences were highly significant (P = less than.0001). First, with the simplification of the technique cost arguments may be easily outweighed by the benefit of using an accurate method. But any baby exceeds 8 pounds, 13 ounces at the time of birth is typically classified as macrosomic. Fetal macrosomia (also sometimes termed large for gestational age) is usually defined when the estimated fetal weight (EFW) is greater than the 90 th percentile. Regardless of the etiology, this condition represents increased risk to the mother and fetus during labor and birth. The predictive power of a positive ratio was 68%, with a sensitivity of 63%. With more than 500 illustrations, including over 150 in color, this book is a must-have reference for all practicing obstetrician-gynecologists, radiologists and sonographers who are interested in maternal-fetal Doppler sonography. Fetal MRI at 36 weeks predicts neonatal macrosomia significantly better than USG: PREMACRO study Dr Nirali Kapoor 6 Sep 2021 3:45 AM GMT Prenatal estimation of fetal weight (EFW) began during the very early days of obstetric ultrasound. ACOG recommends Ultrasound at 18 weeks for all patients. Obstet Gynecol. Postterm pregnancy is a risk factor. Fetal macrosomia occurs in 0.5-15% of all pregnancies 1, 2. Epub 2015 Nov 1. Fetal macrosomia may be identified on routine screening US during pregnancies with risk factors or as an adjunct to a concerning physical examination. 8600 Rockville Pike fetal macrosomia: independent of maternal diabetes 2, in the idiopathic form; mesoblastic nephroma; Pena Shokeir syndrome; maternal overhydration ref; Polyhydramnios is associated with poor outcome if present in combination with intrauterine growth restriction (IUGR); usually seen in aneuploidies 18,13, and 21. Associations of maternal dietary inflammatory potential and quality with offspring birth outcomes: An individual participant data pooled analysis of 7 European cohorts in the ALPHABET consortium. Methods: Studies were identified without language restrictions from MEDLINE (1966-2003), EMBASE (1980-2003), Cochrane Library (2003:4), SCISEARCH (1974-2003) and manual searching of bibliographies of . Long recognized as the authoritative leader in the field, Creasy and Resnik's Maternal-Fetal Medicine, 8th Edition, continues to provide the latest evidence-based guidelines for obstetric and neonatal management, helping you minimize ... Risks associated with fetal macrosomia increase greatly when birth weight is more than 9 pounds, 15 ounces (4,500 grams). The early detection af the macrosomic fetus is important to the obstetric management of pregnancies in which this growth abnormality occurs. To know more, see our. Found insideThis new edition of Fetal and Neonatal Brain Injury brings the reader fully up to date with all advances in clinical management and outcome assessment. The PPV was 29.9 % for MRIEFW and 26.2 % for US-EFW and the NPV was 99.6 for MRI-EFW and 98.8 for US-EFW. [In case of fetal macrosomia, the best strategy is the induction of labor at 38 weeks of gestation]. In this article, we describe the definition, risk factors, diagnosis, prevention, ultrasound monitoring, prenatal care, and delivery in fetal macrosomia cases. Objectives: To assess the effects of a policy of labour induction at or shortly before term (37 to 40 weeks) for suspected fetal macrosomia on theway of giving birth and maternal or perinatal . Additional neonatal risks include many conditions that are common to infants of diabetic mothers, including hypoglycemia, polycythemia, and metabolic and electrolyte abnormalities. Risk factors include: Maternal obesity, defined as a prepregnancy body mass index greater than 30, and excessive gestational weight gain are two important risk factors for macrosomia given the high prevalence of both in the United States. Richly illustrated and comprehensive in scope, Obstetric Imaging, 2nd Edition, provides up-to-date, authoritative guidelines for more than 200 obstetric conditions and procedures, keeping you at the forefront of this fast-changing field.This highly regarded reference covers the extensive and ongoing advances in maternal and fetal imaging in a concise, newly streamlined format for quicker . A nonstress test measures the baby's heart rate in response to his or her own movements. To put it simply, they have the training to diagnose the problem before it becomes a much bigger one. Found inside – Page 871992;79:387–389. 241. Sohaey R, Nyberg DA, Sickler GK, et al. Idiopathic polyhydramnios: association with fetal macrosomia. Radiology. 1994;190:393–396. Moraitis AA, Shreeve N, Sovio U, Brocklehurst P, Heazell AEP, Thornton JG, et al. Found inside – Page 104Uterus Large-for-Dates Commonly seen in: • Hydatidiform mole • Polyhydramnios • Fetal macrosomia • Multiple gestation pregnancy • Inaccurate menstrual ... ACOG Practice Bulletin, Number 216. Birth weights and estimated fetal weights were compared with those of postnatal and prenatal control groups, respectively . Post her MD, she has joined in a Multispeciality hospital in Amritsar. Found insideHigh-quality images aid the reader in coming to an understanding of difficult topics. Completely rewritten and updated, this text features the most current information available. However, some data suggest similar accuracy between US and Leopold maneuvers for predicting macrosomia. Both these groups have higher rates of morbidity and mortality; therefore once identified, managing clinicans have the possibility to modify the timing and/or mode of birth in order to optimize clinical outcomes and minimise perinatal risks. Zhonghua Fu Chan Ke Za Zhi. Although some investigators have found greater accuracy with 3D techniques, at present, there is no evidence to abandon 2D US evaluations. Macrosomia is one of the major fetal consequences of GDM and may lead to several adverse events, such as shoulder dystocia, birth trauma to the fetus or mother, and an increased cesarean delivery rate. In the United States, after 42 weeks’ gestation, 25.3% of fetuses weigh more than 4000 g, and 5.2% weigh more than 4500 g. Found inside – Page 1016Fetal macrosomia Intrauterine membrane in pregnancy A. MEMBRANE OF MATERNAL ORIGIN 1. Uterine septum = incomplete resorption of sagittal septum between the ... Found inside – Page iiThe book is divided into two parts. The first deals with examination of the products of conception after termination of pregnancy for fetal anomaly. The range of pathological abnormality is described and its relevance discussed. Fetal macrosomia is defined as birth weight >4000 g and is associated with several maternal and fetal complications such as maternal birth canal trauma, shoulder dystocia, and perinatal asphyxia. This site needs JavaScript to work properly. Zhang L, Zhai R, Huo Z, Wei Z, Zhang Z, Wei R, Man D. Int J Gen Med. Fetal growth restriction; an estimated or actual weight of the fetus below 10th percentile for gestational age M-mode an ultrasound imaging technique in which structure movement can be depicted in a wave-like manner; primarily used in cardiac and fetal cardiac imaging macrosomia estimated fetal weight of greater than 4000 or 4500 grams Design: Systematic quantitative review. Birth weight centile was considered as the gold standard for the US and MRI-derived centile. Fetal macrosomia is associated with a higher incidence of perinatal morbidity, including shoulder dystocia and brachial plexus injury in the fetus and anal sphincter tears, uterine atony and haemorrhage in the mother. Epub 2016 Oct 19. Maternal diabetes and gestational diabetes are well-recognized risk factors for macrosomia because chronic and intermittent maternal hyperglycemia has been strongly associated with accelerated fetal growth and fat deposition. The purpose of EFW is to follow serial growth and identify fetuses at the extremes, either small or large-for-gestational age (SGA or LGA). eCollection 2021 Jan. BMC Pregnancy Childbirth. There are significant maternal implications that are strongly associated with macrosomic fetuses, including postpartum hemorrhage and subsequent transfusion, perineal trauma, especially third-degree and fourth-degree lacerations after a vaginal birth, infection, and cesarean birth. Chen Y, Wan K, Gong Y, Zhang X, Liang Y, Wang X, Feng P, He F, Zhou R, Yang D, Jia H, Cheng G, Shimokawa T. Sci Rep. 2021 Apr 7;11(1):7591. doi: 10.1038/s41598-021-87135-9. Ontology: Fetal Macrosomia (C0015938) Definition (NCI) A fetus exceeding 4500 grams. Macrosomia describes a fetus or neonate with excessive growth. Written by Dr. Giancarlo Mari, who developed the program and currently trains providers around the U.S. and the world, this volume helps teams strengthen their common knowledge of obstetric emergencies. Objectives To compare the accuracy of antenatal two-dimensional (2D) ultrasound, three-dimensional (3D) ultrasound, and magnetic resonance imaging (MRI) in predicting fetal macrosomia at birth. In thirteen chapters, Dr Panayiotopoulos gives clear and didactic guidance on the diagnosis, treatment and ongoing management of the full spectrum of epileptic syndromes with an insight and perception that only he can bring to the subject ... birth weight; fetal macrosomia; gestational diabetes mellitus; induction of labor; shoulder dystocia; three-dimensional ultrasound; two-dimensional ultrasound. From May 2016 through February 2019, women received counselling at the 36 weeks clinic. Found inside – Page 561Risk factors for PPH include advanced maternal age, multiparity, prolonged labor, retained placenta, polyhydramnios, preeclampsia, and fetal macrosomia.56 ... Methods: We evaluated and compared the prediction accuracies of nonlinear and quadratic mixed-effects models coupled with 26 different empirical formulas for estimating fetal weights in . Multiple risk factors contribute to fetal macrosomia, some of which are discussed subsequently. Privacy, Help No voice calls allowed. Diabetes mellitus is the commonest medical disorder faced during pregnancy and it includes type I, type II, and gestational diabetes. 2021 Jan 21;18(1):e1003491. Formulas were used for fetal weight estimation based on fetal body volume calculated by MRI . 2021 Jan 4;21(1):3. doi: 10.1186/s12884-020-03482-x. The term fetal macrosomia indicates a birth weight of more than 4000 g regardless of gestational age. The value of US may be in its ability to rule out macrosomia rather than confirmation. Confirm dates and Fetal Survey. Fetal macrosomia is defined as birth weight >4000 g and is associated with several maternal and fetal complications such as maternal birth canal trauma, shoulder dystocia, and perinatal asphyxia. Identification and treatment of gestational diabetes. The purpose of this study was to evaluate the prediction of fetal macrosomia based on ultrasound estimates of fetal weight and amniotic fluid volume combined with clinical risk factors. Assessing the relationship between pregravid body mass index and risk of adverse maternal pregnancy and neonatal outcomes: prospective data in Southwest China. Abstract. Macrosomia . It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Epidemiology. III. BPP measures the baby's heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid. The term macrosomia is used to describe a fetus or neonate with excessive growth. The diagnosis of fetal macrosomia is suspected when the estimated fetal weight (EFW) is greater than 4000 g in a diabetic patient and above 4500 g in a nondiabetic patient The estimated fetal weight from the measurements of HC, AC and FL is derived from the formula reported by: Hadlock FP, Harrist RB, Martinez-Poyer J. Varying thresholds have been used, including 4000 g and 4500 g, and both thresholds have been associated with adverse pregnancy outcomes. Covers the latest insights any fetal specialist needs and provides essential knowledge for professionals caring for women with high-risk pregnancies. While acting as a stand-alone text on obstetric care, this volume also forms part of a three-volume set - all authored by leading authorities - on the entirety of obstetric and gynecologic practice. AC often 1st measurement to ↑. Fetal weight cannot be directly measured. New features of this book include a specific range of recommended gain for obese women. Found insideThis book offers a unique and focused study of the use of ultrasound during the first trimester, a critical time in a fetus’ development. A guide to identifying disease processes in the placenta affecting pregnancy outcome, with current diagnostic criteria and clinical consequences. This volume provides an in-depth discussion of both Macrosomia and IUGR. Special consideration has been given to state-of-the-art developments in this important area of obstetrics. If you dont get an email for accessing, please mail to krestkochi@gmail.com or contact h elpline +919110622199 (Whatsapp ONLY). To establish a nomogram model to predict the risk of macrosomia in pregnant women with gestational diabetes mellitus in China. Diabetes is the major risk associated with macrosomia, and this risk is for both the mother and the neonate. J Gynecol Obstet Biol Reprod (Paris). Further Outpatient Care. Background. Here, study suggests a new approach that includes MRI-EFW to identify fetuses at the extremes of growth. FOIA link. The American College of Obstetricians and Gynecologists suggests a threshold of 4500 g for considering changes in management, secondary to estimated fetal weight for women with diabetes, and a threshold of 5000 g for women without diabetes. You agree to our use of cookies by continuing to use our site. Management of gestational diabetes with glucose monitoring, nutritional consultation, and hypoglycemic agents, when indicated, significantly mitigates this risk. does in the prediction for LGA ≥ 95th centile for gestation in a large, unselected population of women at 36 weeks of gestation. >4500g) in its definition. Bookmarks (0) Obstetrics. Fetal macrosomia has been historically defined as birth weights over 4000 g, over 4500 g or over 5000 g. The American College of Obstetrics and Gynecology defines macrosomia as fetal weight of . The finding of fetal macrosomia may require additional screening and counseling before delivery. Epub 2016 May 30. Bookshelf She underwent training in trauma/emergency medicine non academic residency in AIIMS Delhi for an year after her MBBS. From: Diagnostic Gynecologic and Obstetric Pathology (Third Edition), 2018 J Gynecol Obstet Biol Reprod (Paris). Macrosomia, defined as birth weight greater than 4,000 g or greater than 4,500 g, is particularly difficult to accurately predict prenatally. A potential predictor of complications during pregnancy and birth are fetal birth weight. The ASTT and SSTT were evaluated at different times between 21 and 36 . Birth weight > 4,000-4,500 g. AC alone can predict macrosomia. One could argue about the practicality of using fetal MRI for making these predictions in clinical practice with regards to cost and limited availability of most facilities. Obviously, fetal macrosomia is caused, mainly, by the mother and decisions they make before giving birth. Found insideThe manual concludes with WHO specifications for a general purpose scanner judged entirely suitable for 90-95% of the most common ultrasound examinations. The prevalence of macrosomia depends on the definition used and the population studied. Found insideThis book is a comprehensive, superbly illustrated guide to perinatal imaging. It is also one of the first books to provide a systematic comparison of the prenatal findings and the postnatal evolution of disease. 108.2 ). Found inside – Page 604This can be an emergency if fetal activity changes from normal to markedly decreased or ... high amniotic fluid level (polyhydramnios), or fetal macrosomia. 3D ultrasound provides an exciting new and potentially revolutionary method of fetal imaging. A review of different US experiences showed a concerning wide range of sensitivity (12% to 75%), specificity (68% to 99%), and posttest probability (17% to 79%) for identifying macrosomia, highlighting the limitations of US for identifying macrosomia. Nevertheless, identifying macrosomic fetuses is important given the implications on fetal and maternal pregnancy outcomes. eCollection 2021. In many cases, it represents a consequence of a multitude of differing environmental and genetic factors that ultimately result in the macrosomic state. Richly illustrated and comprehensive in scope, Obstetric Imaging, 2nd Edition, provides up-to-date, authoritative guidelines for more than 200 obstetric conditions and procedures, keeping you at the forefront of this fast-changing field. The macrosomic infant may be at risk of developing diabetes and obesity later in . The username & password will be emailed to subscribers after 1 working day on receipt of payment. In a blinded prospective study, PREMACRO, Caroline Kadji et al tested the hypothesis that MRI-EFW performs better than standard US-EFW based on Hadlock et al. . This book is a personal account of the treatment options for brachial plexus injuries sustained by babies at birth. Fetal macrosomia is associated with an increased risk of adverse maternal and neonatal outcomes. Prevention and treatment information (HHS). Found insideThe book is intended for radiologists, however, it is also of interest to clinicians in oncology, cardiology, and pulmonology. This open access book focuses on diagnostic and interventional imaging of the chest, breast, heart, and vessels. Magnetic reso-nance imaging can be used to assess fetal total volume, shoulder width, and fat amount in addition to obtaining accurate pelvic measurements. The Definitive Reference for Obstetric UltrasoundComplete-The most comprehensive work on obstetric ultrasound available, with over 1500 superb illustrations (700 in color)-Textbook and atlas in one-Combined with the gynecologic volume, ... Three-dimensional ultrasound could be an alternative to soft tissue monitoring, allowing better prediction of birth weight than two-dimensional ultrasound. Fetal macrosomia increases the risk that your uterine muscles won''ve had a prior C-section or major uterine surgery, fetal macrosomia increases the risk of uterine rupture during labor — a rare but serious complication in which the uterus tears open along the scar line from the C-section or other uterine surgery. Both clavicular fractures and brachial plexus injuries are more commonly identified in macrosomic neonates after a vaginal delivery. Objectives. There are no universal diagnostic criteria. For example, macrosomia (which is defined as a birth weight greater than 4,000 grams) makes it more difficult for the baby's shoulders to pass through the mother's vagina, and this effect can increase the mother's risk of experiencing vaginal tearing and postpartum bleeding and her likelihood of needing . About 9% of babies worldwide weigh more than 8 pounds, 13 ounces. Secondary outcomes included the comparative prediction of LGA neonates ≥ 90th, 97th, 99th centile, small-for-gestational age (SGA) ≤ 10th, 5th, 3th centile for gestational age and maternal/perinatal complications. 56. It also evaluated the performance of MRI-EFW and US-EFW in the prediction of LGA and SGA at various cut-offs. Early identification of risk factors could allow preventive measures to be taken to avoid adverse perinatal outcomes. Fetal macrosomia occurs in 0.5-15% of all pregnancies 1, 2. The Fetal Medicine Foundation is aware of the General Data Protection Regulation and changes to data protection legislation. Click the link below to register for Fetal Radiology Recorded videos. 2016. Pregnancy outcome following ultrasound diagnosis of macrosomia. Fetal macrosomia is distinct from the term "large for gestational age" ("LGA"). Found insiderare fetal overgrowth disorder characterized by visceromegaly, renal lesions, ... cystic hygroma √ fetal macrosomia √ macrocephaly √ agenesis of corpus ... (NICHD) Definition (MSH) A condition of fetal overgrowth leading to a large-for-gestational-age FETUS. For a fixed false-positive rate of 5%, detection rates of birthweight ≥ 95th centile by MRI-EFW was 80.0% whereas it was only 59.1% using US-EFW. ↑ Glycogen stores in liver. 1991 Sep;78(3 Pt 1):340-3. Association of Normal-Range Hemoglobin A1c Value During Midpregnancy with Adverse Birth Outcomes. Please enable it to take advantage of the complete set of features! If your health care provider suspects fetal macrosomia, he or she might perform antenatal testing, such as a nonstress test or a fetal biophysical profile, to monitor your baby's well-being. The AUROC curves for prediction of LGA ≥ 90th, 97th , 99th centile and SGA ≤ 10th, 5th , 3 th centile was significantly larger by prenatal MRI as compared to US (p<0.05 for all). It is defined as BIRTH WEIGHT greater than 4,000 grams or above the 90th percentile for population and sex-specific growth curves. Genetic syndromes are rare in fetuses with macrosomia without other findings but must be considered, especially when other congenital abnormalities are identified (see Differential Diagnosis From Imaging Findings ). Keywords: PMID:29456581 57. The group of Alexander and Himes set the limit at 4500 g by putting the acronym LGA (large for gestational age) as a terminology that indicates a birth weight higher than 90° centile for the gestational age, for which LAG can be a fetus of 3500 g born at 34 weeks. It may predispose to various complications including fetus malformation, macrosomia, spontaneous abortion, stillbirth, neonatal death, and intrauterine growth retardation [].Risk of congenital anomalies is increased in diabetic mothers' infants with estimation . Large for gestational age fetus. Future interventional studies based on a more accurate method of fetal weight estimation need to be conducted in order to determine whether this could improve neonatal and maternal morbidity or alternatively, whether this could reduce unnecessary intervention such as caesarean sections and induction of labor, while maintaining stable neonatal and maternal related morbidity.".

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