Archives of Gynecology and Obstetrics

, Volume 298, Issue 6, pp 1123–1129 | Cite as

Birthweight thresholds for increased risk for maternal and neonatal morbidity following vaginal delivery: a retrospective study

  • Eran Ashwal
  • Alexandra Berezowsky
  • Sharon Orbach-ZingerEmail author
  • Nir Melamed
  • Amir Aviram
  • Eran Hadar
  • Yariv Yogev
  • Liran Hiersch
Maternal-Fetal Medicine



To determine neonatal birthweight (BW) thresholds for adverse maternal and neonatal outcome following vaginal delivery.


A retrospective cohort study of all women with singleton pregnancies who underwent vaginal delivery in a university-affiliated tertiary hospital (1996–2015). The association between BW and adverse outcome in neonates with BW ≥ 3500 g (> 90th centile BW at 37 weeks’ gestation) with 100 g-increment groups was explored. Pregnancies complicated by diabetes mellitus, fetal anomalies or cesarean deliveries were excluded. The composite neonatal outcome was defined as shoulder dystocia or brachial plexus injury. The composite maternal outcome was defined as postpartum hemorrhage or third- or fourth-degree perineal tears.


Of the 121,728 deliveries during the study period, 26,920 (22.1%) met inclusion criteria. Of these, 1024 (3.8%) had a composite adverse maternal outcome and 947 (3.5%) had a composite adverse neonatal outcome. The rates of composite maternal outcomes increased significantly only at a BW of 4800 g and above. The composite neonatal outcomes increased significantly only at a BW of 4400 g and above. In multivariate analysis, after subcategorizing our cohort into 3 BW groups [3500–3999 g (control, n = 23,030); 4000–4399 g (n = 3494); ≥ 4400 g (n = 396)], BW was associated with adverse neonatal outcomes in a dose-dependent manner. In the BW ≥ 4400 g group, to prevent one case of shoulder dystocia or Erb’s palsy, 12 cesarean deliveries needed to be performed.


For non-diabetic mothers who deliver vaginally, neonatal BW ≥ 4400 g was associated with a significant increase in adverse neonatal outcomes, whereas neonatal BW ≥ 4800 g was associated with a significant increase in adverse maternal outcomes.


Birthweight Vaginal delivery Shoulder dystocia Adverse neonatal outcome 


Author contributions

EA, helped design the study, conduct the study, analyze the data, write the manuscript review and edit the manuscript. AB helped conduct the study. SO-Z helped write and edit the manuscript. NM helped conduct the study, reviewed and edited the manuscript. AA helped design the study, conduct the study and analyze the data. EH helped design the study, helped reviewed and edit the manuscript. YY helped design the study, helped conduct the study and helped reviewed and edit the manuscript. LH helped design the study, conduct the study, analyze the data, write the manuscript review and edit the manuscript.


All funding for this study was departmental.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was performed in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study received Institutional review board from Rabin Medical’s Center Helsinki committee. As it was a retrospective study, study formal consent is not required.


  1. 1.
    Benedetti TJ, Gabbe SG (1978) Shoulder dystocia. A complication of fetal macrosomia and prolonged second stage of labor with midpelvic delivery. Obstet Gynecol 52(5):526–529PubMedGoogle Scholar
  2. 2.
    Spong CY, Beall M, Rodrigues D, Ross MG (1995) An objective definition of shoulder dystocia: prolonged head-to-body delivery intervals and/or the use of ancillary obstetric maneuvers. Obstet Gynecol 86(3):433–436. CrossRefPubMedGoogle Scholar
  3. 3.
    Boyd ME, Usher RH, McLean FH (1983) Fetal macrosomia: prediction, risks, proposed management. Obstet Gynecol 61(6):715–722PubMedGoogle Scholar
  4. 4.
    Ecker JL, Greenberg JA, Norwitz ER, Nadel AS, Repke JT (1997) Birth weight as a predictor of brachial plexus injury. Obstet Gynecol 89(5 Pt 1):643–647CrossRefGoogle Scholar
  5. 5.
    American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics (2016) Practice Bulletin No. 173: fetal macrosomia. Obstet Gynecol 128(5):e195–e209. CrossRefGoogle Scholar
  6. 6.
    Parks DG, Ziel HK (1978) Macrosomia. A proposed indication for primary cesarean section. Obstet Gynecol 52(4):407–409PubMedGoogle Scholar
  7. 7.
    Langer O, Berkus MD, Huff RW, Samueloff A (1991) Shoulder dystocia: should the fetus weighing greater than or equal to 4000 grams be delivered by cesarean section? Am J Obstet Gynecol 165(4 Pt 1):831–837CrossRefGoogle Scholar
  8. 8.
    Lipscomb KR, Gregory K, Shaw K (1995) The outcome of macrosomic infants weighing at least 4500 grams: Los Angeles County + University of Southern California experience. Obstet Gynecol 85(4):558–564. CrossRefPubMedGoogle Scholar
  9. 9.
    Menticoglou SM, Manning FA, Morrison I, Harman CR (1992) Must macrosomic fetuses be delivered by a caesarean section? A review of outcome for 786 babies greater than or equal to 4,500 g. Aust N Z J Obstet Gynaecol 32(2):100–103CrossRefGoogle Scholar
  10. 10.
    Dollberg S, Haklai Z, Mimouni FB, Gorfein I, Gordon ES (2005) Birth weight standards in the live-born population in Israel. Isr Med Assoc J IMAJ 7(5):311–314PubMedGoogle Scholar
  11. 11.
    Raio L, Ghezzi F, Di Naro E, Buttarelli M, Franchi M, Durig P, Bruhwiler H (2003) Perinatal outcome of fetuses with a birth weight greater than 4500 g: an analysis of 3356 cases. Eur J Obstet Gynecol Reprod Biol 109(2):160–165CrossRefGoogle Scholar
  12. 12.
    Rossi AC, Mullin P, Prefumo F (2013) Prevention, management, and outcomes of macrosomia: a systematic review of literature and meta-analysis. Obstet Gynecol Surv 68(10):702–709. CrossRefPubMedGoogle Scholar
  13. 13.
    Bjorstad AR, Irgens-Hansen K, Daltveit AK, Irgens LM (2010) Macrosomia: mode of delivery and pregnancy outcome. Acta Obstet Gynecol Scand 89(5):664–669. CrossRefPubMedGoogle Scholar
  14. 14.
    Jenner ZB, O’Neil Dudley AE, Mendez-Figueroa H, Ellis VS, Chen HY, Chauhan SP (2017) Morbidity associated with fetal macrosomia among women with diabetes mellitus. Am J Perinatol. CrossRefPubMedGoogle Scholar
  15. 15.
    Committee on Practice B-O (2017) Practice Bulletin No. 180: gestational diabetes mellitus. Obstet Gynecol 130(1):e17–e37. CrossRefGoogle Scholar
  16. 16.
    Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, Thieda P, Lux LJ, Lohr KN (2009) A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol 201(4):339.e1–14. CrossRefPubMedGoogle Scholar
  17. 17.
    Cedergren M (2006) Effects of gestational weight gain and body mass index on obstetric outcome in Sweden. Int J Gynaecol Obstet 93(3):269–274. CrossRefPubMedGoogle Scholar
  18. 18.
    Zhang J, Kim S, Grewal J, Albert PS (2012) Predicting large fetuses at birth: do multiple ultrasound examinations and longitudinal statistical modelling improve prediction? Paediatr Perinat Epidemiol 26(3):199–207. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Melamed N, Yogev Y, Meizner I, Mashiach R, Ben-Haroush A (2010) Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med Off J Am Inst Ultrasound Med 29(2):225–230CrossRefGoogle Scholar
  20. 20.
    Aviram A, Yogev Y, Ashwal E, Hiersch L, Danon D, Hadar E, Gabbay-Benziv R (2017) Different formulas, different thresholds and different performance-the prediction of macrosomia by ultrasound. J Perinatol Off J Calif Perinat Assoc 37(12):1285–1291. CrossRefGoogle Scholar
  21. 21.
    Gherman RB, Ouzounian JG, Miller DA, Kwok L, Goodwin TM (1998) Spontaneous vaginal delivery: a risk factor for Erb’s palsy? Am J Obstet Gynecol 178(3):423–427CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Helen Schneider Hospital for WomenRabin Medical CenterPetach TikvaIsrael
  2. 2.Lis Maternity HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
  3. 3.Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of AnesthesiaRabin Medical Center/Beilinson HospitalPetach TikvaIsrael
  5. 5.Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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