This review examines and summarises the literature regarding the mode of delivery of macrosomic infants and subsequent perinatal outcomes. A search of electronic databases was conducted and supplemented with investigation of the references cited in the original articles. Although the rates of obstetric complications differ among high birth weight infants delivered by caesarean section compared to those delivered vaginally, there is currently little evidence that perinatal mortality differs significantly by delivery method. Shoulder dystocia and birth injury occur with greater frequency among macrosomic infants, yet the relative inaccuracy of clinical and ultrasonographic estimates of birth weight among high birth weight infants indicates that a trial of labour may be warranted among non-diabetic mothers with a suspected macrosomic fetus. The majority of studies identified in this review utilised small sample sizes and observational design, thereby hindering valid assessments of the impact of delivery method on the mortality of this population. Consequently, an optimal management strategy has yet to be defined.

OBJECTIVES: This study examined changes in the reporting of very low-birthweight infants in Alabama from 1974 to 1994 and the impact on perinatal mortality rates. METHODS: Linked live birth, neonatal death, and stillbirth records of infants born weighing less than 1500 g were compared. RESULTS: The changes in mortality over time ranged from a drop from 100% to 92% in the under-500-g group to a drop from 39% to 4% in the 1000-to 1499-g group. The percentage of total births weighing less than 500 g increased by 155%; the percentage of 1000- to 1499-g births increased by only 7%. As a result, the percentage of neonatal mortality attributable to live births below 500 g increased from 3% to 32%. CONCLUSIONS: Increased reporting of births below 500 g has masked improvements in neonatal mortality.

No abstract

There is little information on mortality among multiple gestations complicated by premature rupture of membranes (PROM). In this study, we estimated the occurrence of the components of early mortality (stillbirth, neonatal and infant mortality) among twin pregnancies using the generalised estimating equation framework to account for intra-cluster correlations. Using the population-attributable risk, we also computed the level of excess mortality that could be averted by preventing PROM. Our findings reveal that the likelihood of stillbirth (odds ratio (OR) = 1.88; 95% confidence interval (CI)=1.66-2.13), neonatal mortality (OR=3.45; 95% CI=3.18-3.74) and infant mortality (OR=3.26; 95% CI=3.03-3.50) was significantly higher among twin pregnancies exposed to PROM. Approximately 6% of all stillbirths, 15% of neonatal mortality and 14% of infant mortality among twins in the United States are attributable to PROM. We conclude that PROM is associated with an increased level of early mortality among twins.

No abstract