Does prenatal identification of fetal macrosomia change management and outcome?
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To assess whether there is an association between predicted fetal macrosomia and adverse outcomes in macrosomic newborns (> 4000 g), based on a sonographic evaluation up to 2 weeks prior to delivery.
A retrospective cohort study of 3098 mothers of macrosomic babies who were delivered at our institution (2000–2015). We compared the management and outcomes of women with predicted fetal macrosomia with that of women with unknown fetal macrosomia. The primary outcomes were cesarean section (CS) rate and postpartum hemorrhage. Secondary outcomes were composite maternal and neonatal outcomes and birth injuries.
In 601 (19.4%) women fetal macrosomia was predicted, and in 2497 (80.6%) women, fetal macrosomia was unknown. CS rate was more than 3.5 times higher in the group of predicted macrosomia (47.2% vs. 12.7%, P < 0.001) than those with unpredicted macrosomia; not only due to non-progressive labor, but for non-reassuring heart rate as well. However, predicted fetal macrosomia reduced the risk of postpartum hemorrhage (aOR 0.5, 95% CI 0.2–1.0), maternal (aOR 0.3, 95% CI 0.2–0.5) and neonatal composite adverse outcomes (aOR 0.7 95% CI 0.6–0.9). It was also associated with increased risk for induction of labor, episiotomy, 3rd- or 4th-degree tears and a longer maternal hospitalization. Birth injuries and shoulder dystocia were not different between the groups.
Antepartum CS was found to be associated with predicted fetal macrosomia. Moreover, a planned CS due to macrosomia was associated with reduced risk for postpartum hemorrhage, maternal and neonatal outcome, even for babies with a mean birth weight < 4500 g.
KeywordsBirth injuries Cesarean section Fetal macrosomia Maternal outcome Postpartum hemorrhage Shoulder dystocia
DV—manuscript writing, data collection and management, data analysis. IB—data collection. EK-P—data collection. HL—manuscript editing. SS—protocol development, data management. RG—protocol and project development, data analysis, manuscript editing.
All authors declare no funding of any kind.
Compliance with ethical standards
Conflict of interest
All authors declare no conflict of interests. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. IRB was approved on 28th April 2015. Number of approval was 0044-15-BNZ.
Due to the retrospective nature of the study, there was no need for informed consent.
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