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Does prenatal identification of fetal macrosomia change management and outcome?

  • Dana VitnerEmail author
  • Inna Bleicher
  • Einav Kadour-Peero
  • Hayley Lipworth
  • Shlomi Sagi
  • Ron Gonen
Maternal-Fetal Medicine
  • 27 Downloads

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Birth injuries Cesarean section Fetal macrosomia Maternal outcome Postpartum hemorrhage Shoulder dystocia 

Notes

Author contribution

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.

Funding

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.

Ethical approval

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.

Informed consent

Due to the retrospective nature of the study, there was no need for informed consent.

References

  1. 1.
    (2016) ACOG Practice Bulletin—fetal macrosomia number 173. Obstet Gynecol 128:e195–e209Google Scholar
  2. 2.
    (2017) Practice bulletin no 178: shoulder dystocia. Obstet Gynecol 129:e123–e133Google Scholar
  3. 3.
    American College of O, Gynecologists (2009) ACOG practice bulletin no. 106: intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 114:192–202CrossRefGoogle Scholar
  4. 4.
    American College of O, Gynecologists, Society for Maternal-Fetal M, Caughey AB, Cahill AG, Guise JM, Rouse DJ (2014) Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol 210:179–193CrossRefGoogle Scholar
  5. 5.
    Blackwell SC, Refuerzo J, Chadha R, Carreno CA (2009) Overestimation of fetal weight by ultrasound: does it influence the likelihood of cesarean delivery for labor arrest? Am J Obstet Gynecol 200:340.e341–340.e343CrossRefGoogle Scholar
  6. 6.
    Buck Louis GM, Grewal J, Albert PS, Sciscione A, Wing DA, Grobman WA, Newman RB, Wapner R, D’Alton ME, Skupski D, Nageotte MP, Ranzini AC, Owen J, Chien EK, Craigo S, Hediger ML, Kim S, Zhang C, Grantz KL (2015) Racial/ethnic standards for fetal growth: the NICHD fetal growth studies. Am J Obstet Gynecol 213:449.e441CrossRefGoogle Scholar
  7. 7.
    Drooger JC, Troe JW, Borsboom GJ, Hofman A, Mackenbach JP, Moll HA, Snijders RJ, Verhulst FC, Witteman JC, Steegers EA, Joung IM (2005) Ethnic differences in prenatal growth and the association with maternal and fetal characteristics. Ultrasound Obstet Gynecol 26:115–122CrossRefGoogle Scholar
  8. 8.
    Esakoff TF, Cheng YW, Sparks TN, Caughey AB (2009) The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol 200:672.e671–672.e674CrossRefGoogle Scholar
  9. 9.
    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 183:1296–1300CrossRefGoogle Scholar
  10. 10.
    Grantz KL, Hediger ML, Liu D, Buck Louis GM (2018) Fetal growth standards: the NICHD fetal growth study approach in context with INTERGROWTH-21st and the World Health Organization Multicentre Growth Reference Study. Am J Obstet Gynecol 218:S641 e628–S655 e628CrossRefGoogle Scholar
  11. 11.
    Hankins GD, Speer M (2003) Defining the pathogenesis and pathophysiology of neonatal encephalopathy and cerebral palsy. Obstet Gynecol 102:628–636PubMedGoogle Scholar
  12. 12.
  13. 13.
    Ju H, Chadha Y, Donovan T, O’Rourke P (2009) Fetal macrosomia and pregnancy outcomes. Aust N Z J Obstet Gynaecol 49:504–509CrossRefGoogle Scholar
  14. 14.
    King JR, Korst LM, Miller DA, Ouzounian JG (2012) Increased composite maternal and neonatal morbidity associated with ultrasonographically suspected fetal macrosomia. J Matern Fetal Neonatal Med 25:1953–1959CrossRefGoogle Scholar
  15. 15.
    Kiserud T, Piaggio G, Carroli G, Widmer M, Carvalho J, Neerup Jensen L, Giordano D, Cecatti JG, Abdel Aleem H, Talegawkar SA, Benachi A, Diemert A, Tshefu Kitoto A, Thinkhamrop J, Lumbiganon P, Tabor A, Kriplani A, Gonzalez Perez R, Hecher K, Hanson MA, Gulmezoglu AM, Platt LD (2017) The World Health Organization fetal growth charts: a multinational longitudinal study of ultrasound biometric measurements and estimated fetal weight. PLoS Med 14:e1002220CrossRefGoogle Scholar
  16. 16.
    Kiserud T, Benachi A, Hecher K, Perez RG, Carvalho J, Piaggio G, Platt LD (2018) The World Health Organization fetal growth charts: concept, findings, interpretation, and application. Am J Obstet Gynecol 218:S619–S629CrossRefGoogle Scholar
  17. 17.
    Little SE, Edlow AG, Thomas AM, Smith NA (2012) Estimated fetal weight by ultrasound: a modifiable risk factor for cesarean delivery? Am J Obstet Gynecol 207:309.e301–309.e306CrossRefGoogle Scholar
  18. 18.
    Polin RA, Committee on F, Newborn (2012) Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics 129:1006–1015CrossRefGoogle Scholar
  19. 19.
    Sadeh-Mestechkin D, Walfisch A, Shachar R, Shoham-Vardi I, Vardi H, Hallak M (2008) Suspected macrosomia? Better not tell. Arch Gynecol Obstet 278:225–230CrossRefGoogle Scholar
  20. 20.
    Siggelkow W, Boehm D, Skala C, Grosslercher M, Schmidt M, Koelbl H (2008) The influence of macrosomia on the duration of labor, the mode of delivery and intrapartum complications. Arch Gynecol Obstet 278:547–553CrossRefGoogle Scholar
  21. 21.
    Sokol RJ, Blackwell SC (2003) ACOG practice bulletin: shoulder dystocia. Number 40, November 2002. (Replaces practice pattern number 7, October 1997). Int J Gynaecol Obstet 80:87–92CrossRefGoogle Scholar
  22. 22.
    Solon JG, Egan C, McNamara DA (2013) Safe surgery: how accurate are we at predicting intra-operative blood loss? J Eval Clin Pract 19:100–105CrossRefGoogle Scholar
  23. 23.
    Stafford I, Dildy GA, Clark SL, Belfort MA (2008) Visually estimated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol 199:519.e511–519.e517Google Scholar
  24. 24.
    Stirnemann J, Villar J, Salomon LJ, Ohuma E, Ruyan P, Altman DG, Nosten F, Craik R, Munim S, Cheikh Ismail L, Barros FC, Lambert A, Norris S, Carvalho M, Jaffer YA, Noble JA, Bertino E, Gravett MG, Purwar M, Victora CG, Uauy R, Bhutta Z, Kennedy S, Papageorghiou AT, International F, Newborn Growth Consortium for the 21st C, Scientific Advisory C, Steering C, st I, st I, Executive C, In addition for Is, Project Coordinating U, Data Analysis G, Data Management G, In addition for Is, Ultrasound G, In addition for I-s, Anthropometry G, In addition for I-s, Laboratory Processing G, Neonatal G, Environmental Health G, Neurodevelopment G, Participating c, local i, In addition for I-s, In addition for I-s (2017) International estimated fetal weight standards of the INTERGROWTH-21(st) Project. Ultrasound Obstet Gynecol 49:478–486CrossRefGoogle Scholar
  25. 25.
    Vendittelli F, Rivière O, Bréart G (2012) Is prenatal identification of fetal macrosomia useful? Eur J Obstet Gynecol Reprod Biol 161:170–176CrossRefGoogle Scholar
  26. 26.
    Walsh JM, McAuliffe FM (2012) Prediction and prevention of the macrosomic fetus. Eur J Obstet Gynecol Reprod Biol 162:125–130CrossRefGoogle Scholar
  27. 27.
    Weeks JW, Pitman T, Spinnato JA 2nd (1995) Fetal macrosomia: does antenatal prediction affect delivery route and birth outcome? Am J Obstet Gynecol 173:1215–1219CrossRefGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Rambam Health Care Campus, Bnai-Zion Medical Center, HaifaIsrael Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of TechnologyHaifaIsrael
  2. 2.Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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