Abstract
Objective
This study assessed the perinatal outcome in a series of macrosomic fetuses with mothers from a general obstetric population in whom vaginal delivery was planned.
Methods
In all, 215 women with macrosomic infants were included from a total of 2,622 deliveries. The pattern of maternal weight gain in pregnancy, the influence of fetal macrosomia on the duration of labor and the delivery outcome were investigated in this group. The main issues studied were the impact of fetal weight on the mode of delivery, the duration of the two stages of delivery and the incidence of intrapartum complications in fetuses larger than 4,000 g in comparison with normal-weight fetuses.
Results
Complete data were obtained for 594 patients, including 215 macrosomic infants and 379 randomly assessed normal-weight infants. With regard to the mode of delivery, a direct correlation was observed between maternal weight gain and the incidence of secondary cesarean section (P < 0.014) when vaginal delivery was initially planned. There was also a direct correlation between increasing birth weight and a higher incidence of secondary cesarean section and assisted vaginal delivery (P < 0.002). In the first stage of labor, there was a statistically significant difference for obstructed labor between the two groups (P < 0.03). The rate of perineal injuries and the incidence of postpartum hemorrhage were similar in the two groups.
Conclusions
As some of the risk factors identified are known prior to delivery, every woman in whom there is a suspicion that the fetus may weigh up to 4,500 g should receive individual guidance regarding special intrapartum and perinatal conditions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Haram K, Pirhonen J, Bergsjo P (2002) Suspected big baby: a difficult clinical problem in obstetrics. Acta Obstet Gynecol Scand 81(3):185–194
Lazer S, Biale Y, Mazor M, Lewenthal H, Insler V (1986) Complications associated with the macrosomic fetus. J Reprod Med 31(6):501–505
Lipscomb KR, Gregory K, Shaw K (1995) The outcome of macrosomic infants weighing at least 4,500 grams: Los Angeles County + University of Southern California experience. Obstet Gynecol 85(4):558–564
Berard J, Dufour P, Vinatier D, Subtil D, Vanderstichele S, Monnier JC et al (1998) Fetal macrosomia: risk factors and outcome. A study of the outcome concerning 100 cases >4,500 g. Eur J Obstet Gynecol Reprod Biol 77(1):51–59
Boulet SL, Salihu HM, Alexander GR (2006) Mode of delivery and the survival of macrosomic infants in the United States, 1995–1999. Birth 33(4):278–283
Wikstrom I, Axelsson O, Bergstrom R, Meirik O (1988) Traumatic injury in large-for-date infants. Acta Obstet Gynecol Scand 67(3):259–264
Impey L, Hobson J, O’Herlihy C (2000) Graphic analysis of actively managed labor: prospective computation of labor progress in 500 consecutive nulliparous women in spontaneous labor at term. Am J Obstet Gynecol 183(2):438–443
Golditch IM, Kirkman K (1978) The large fetus. Management and outcome. Obstet Gynecol 52(1):26–30
Mathew M, Machado L, Al-Ghabshi R, Al-Haddabi R (2005) Fetal macrosomia. Risk factor and outcome. Saudi Med J 26(1):96–100
Mello G, Parretti E, Mecacci F, Lucchetti R, Lagazio C, Pratesi M et al (1997) Risk factors for fetal macrosomia: the importance of a positive oral glucose challenge test. Eur J Endocrinol 137(1):27–33
Oral E, Cagdas A, Gezer A, Kaleli S, Aydinli K, Ocer F (2001) Perinatal and maternal outcomes of fetal macrosomia. Eur J Obstet Gynecol Reprod Biol 99(2):167–171
Raio L, Ghezzi F, Di Naro E, Buttarelli M, Franchi M, Durig P et al (2003) Perinatal outcome of fetuses with a birth weight greater than 4,500 g: an analysis of 3,356 cases. Eur J Obstet Gynecol Reprod Biol 109(2):160–165
Gilbert WM, Nesbitt TS, Danielsen B (1999) Associated factors in 1,611 cases of brachial plexus injury. Obstet Gynecol 93(4):536–540
Nassar AH, Usta IM, Khalil AM, Melhem ZI, Nakad TI, Abu Musa AA (2003) Fetal macrosomia (> or =4,500 g): perinatal outcome of 231 cases according to the mode of delivery. J Perinatol 23(2):136–141
Gonen R, Bader D, Ajami M (2000) Effects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery. Am J Obstet Gynecol 183(5):1296–1300
Lim JH, Tan BC, Jammal AE, Symonds EM (2002) Delivery of macrosomic babies: management and outcomes of 330 cases. J Obstet Gynaecol 22(4):370–374
Rouse DJ, Owen J (1999) Prophylactic cesarean delivery for fetal macrosomia diagnosed by means of ultrasonography–A Faustian bargain? Am J Obstet Gynecol 181(2):332–338
Navti OB, Ndumbe FM, Konje JC (2007) The peri-partum management of pregnancies with macrosomic babies weighing > or =4,500 g at a tertiary university hospital. J Obstet Gynaecol 27(3):267–270
Sadeh-Mestechkin D, Walfisch A, Shachar R, Shoham-Vardi I, Vardi H, Hallak M (2008) Suspected macrosomia? Better not tell. Arch Gynecol Obstet. Feb 26 (Epub ahead of print)
Simhayoff N, Sheiner E, Levy A, Hammel RD, Mazor M, Hallak M (2004) To induce or not to induce labor: a macrosomic dilemma. Gynecol Obstet Invest 58(3):121–125
Gharoro EP, Enabudoso EJ (2006) Labour management: an appraisal of the role of false labour and latent phase on the delivery mode. J Obstet Gynaecol 26(6):534–537
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Siggelkow, W., Boehm, D., Skala, C. et al. The influence of macrosomia on the duration of labor, the mode of delivery and intrapartum complications. Arch Gynecol Obstet 278, 547–553 (2008). https://doi.org/10.1007/s00404-008-0630-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-008-0630-7