Fetal macrosomia--an obstetrician's nightmare?

OBJECTIVES: Fetal macrosomia is defined as a fetus that is of large size for gestational age, i.e. equal to or greater than the 90th percentile of weight. There is some evidence of increased perinatal mortality and morbidity rates in cases of macrosomia.

DESIGN: This is a retrospective study of patients with term pregnancy. We analyzed the deliveries of 508 infants born with birth weight ≥ 4 200 grams and considered them as a study group. The deliveries of newborns with birth weight less than 4 000 g constituted the control group (330 cases). Maternal and neonatal medical records were retrospectively reviewed for clinical data.

SETTING: The study was conducted in Second Department of Obstetrics and Gynecology Warsaw Medical University from January 2004 to December 2007.

RESULTS: Maternal age, parity, BMI and pregnancy weight gain were positively related to fetal macrosomia. Prolonged first stage of labor, cesarean section rate and increased blood loss were observed more frequent in macrososmia. There were no differences between both groups according to Apgar score and neonatal birth trauma. Macrosomia was observed more frequent in male fetuses. Our data showed that careful qualification to way of delivery let us achieve the same good outcome in macrosomia.

CONCLUSIONS: Older obese multiparas are at increased risk of having macrosomic baby. The increased incidence of cesarean section in these women is due to cephalo-pelvic disproportion or obstructed labor. Macrosomia is more often in male fetuses.

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