Big babies, big problems? Fetal macrosomia: clinical variables and maternal and perinatal outcome associated with mode of delivery
Date
2010-02-23T12:28:49Z
Authors
Toweel, Gabrielle Dominique
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Abstract
Objectives
• To determine the prevalence of macrosomic babies delivered at Coronation
(now Rahima Moosa) Hospital.
• To compare the maternal and neonatal outcome of vaginally born
macrosomic babies versus vaginally born babies less than 4000g.
• To determine the impact that mode of delivery of the macrosomic babies
had on maternal and neonatal outcome.
• To compare clinical variables for macrosomia with those published in the
literature, in view of identifying predictive factors.
Method
Retrospective record review of all women who delivered at Coronation (Rahima
Moosa) Hospital from 1 January 2005- 30 June 2005.
Results
A total of 134 macrosomic infants were identified, of which 76 were delivered
vaginally, 14 by elective caesarean section and 44 by emergency caesarean
section. During the study period, there were 5800 deliveries. The incidence of
macrosomia in the study population was 2.3%. Characteristics specific to the
iv
cohort of macrosomic infants revealed that male sex was more common (52/74
(70%) in the macrosomic group vs. 32/74 (43%) in the non-macrosomic group,
p<0.0009), length of labour was increased (13.7 vs. 10.9 hours, p=0.032), as was
use of augmentation (16 vs. 5, p=0.009), perineal trauma (34 vs.19, p=0.010) post
partum haemorrhage (10 vs.2, p=0.016) and shoulder dystocia (5 vs. 0, p=0.03).
Vaginal delivery, compared to elective or emergency caesarean section resulted in
less fetal distress (1 vs. 13, p<0.0001) and puerperal fever (4 vs. 19, p=0.0001).
Differences in other fetal and maternal outcomes were not significant.
Conclusion
Fetal macrosomia was more likely to be associated with advanced gestational
age, male sex, prolonged labour, post partum haemorrhage, use of augmentation,
increased perineal trauma especially episiotomy and shoulder dystocia .
Expectant management, progressing labour according to a standardized
partogram and no elective caesarean section on the basis of clinical and or
ultrasound diagnosis of an increased estimated fetal weight, appears to be the
best form of management for the suspected macrosomic.
Description
MMed (Obstetrics and Gynaecology) Faculty of Health Sciences, University of the Witwatersrand, 2009
Keywords
delivery, big babies