Big babies, big problems? Fetal macrosomia: clinical variables and maternal and perinatal outcome associated with mode of delivery

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.