Determinants and outcome of fetal macrosomia in a Nigerian tertiary hospital

Abstract

Background:To determine the incidence and risk factors of fetal macrosomia and maternal and perinatal outcome.Patients and Methods:This was a 1-year prospective case–control study of singleton pregnancies in a Nigerian tertiary hospital. Only women who gave consent were recruited for the study. The maternal and perinatal outcomes in women who delivered macrosomic infants (birth weight ≥ 4000 g) were compared with the next consecutive delivery of normal birth weight (2500–3999 g) infants.Results:The total deliveries for the study period were 2437, of which 135 were macrosomic babies. The incidence of fetal macrosomia was 5.5%. The mean birth weights of macrosomic and nonmacrosomic babies were 4.26 ± 0.29 kg and 3.20 ± 0.38 kg, respectively, P = 0.000. Mothers with macrosomic babies were more likely to be older (P = 0.047), of higher parity (0.001), taller (P = 0.007), and weighed more at delivery (P = 0.000). Previous history of fetal macrosomia (P = 0.000) and maternal diabetes (P = 0.007) were factors strongly associated with the delivery of macrosomic infants. Pregnancies associated with fetal macrosomia had increased duration of labor (P = 0.007), interventional deliveries (P = 0.000), shoulder dystocia, and genital laceration (P = 0.000). There was no significant difference in the incidence of primary postpartum hemorrhage (P = 0.790), birth asphyxia, and perinatal mortality (P = 0.197).Conclusion:Fetal macrosomia is associated with maternal and fetal morbidities. The presence of the observed risk factors should elicit the suspicion of a macrosomic fetus and the need for appropriate management to reduce maternal and fetal morbidities.

Determination of the Intervention Strategies for the Prevention of Fetal Macrosomia Dependent Cesarean Sections in Nigeria

“…This was within the range of 3%-15% reported by Muhamadbeigi et al, (2011) [20]. It was also consistent with rates reported by other studies in southern Nigeria but it was higher than the rate reported in similar study in the University of Benin Teaching, Benin City where Olokor et al, (2015) [19] found a prevalence rate of 5.4%. This intra-city variation in prevalence rate may be due to the higher clientele in St. Philomena's Hospital due to easier accessibility and affordability.…”

“…In Nigeria, prevalence of fetal macrosomia seems to vary according to the geographical regions. While it is higher in the rain forest regions in the southern parts of Nigeria, [19,21,22] it is relatively less in the savannah regions of Northern regions [23]. The variations in prevalence according to geographical region may be suggestive of dietary factors and cultural habits as predisposing factors of fetal macrosomia.…”

“…The variations in prevalence according to geographical region may be suggestive of dietary factors and cultural habits as predisposing factors of fetal macrosomia. The prevalence of fetal macrosomia has been reported as 8.1% in Enugu, Eastern Nigeria, [21] 7.4% in Port Harcourt, South-south, Nigeria [22] (On 5.4% in Benin City, South -south, Nigeria [19] and 4.2% in Zaria, Northern Nigeria [23].…”

“…5.4% prevalence for fetal macrosomia in Benin City. [19] q is 1.0 -p e.g 0.946 d is the degree of accuracy desired. Usually set at 0.05 or 0.02.…”

Macrosomic Newborn Anthropometric Parameters and the Mode of Delivery

“…Some authors have indeed shown a relation between dystocia and increasing macrosomic weight [25], interventional deliveries, shoulder dystocia, and genital laceration [26], but we found no relation between fetal weight and mode of delivery (p=0,156, Table 5). Bekdas et al analyzing 509 macrosomic newborns from non-diabetic mothers with 500 healthy ones, also found no difference in the mode of delivery, [4], revealing the probability of the implication of other fetal anthropometric factors.…”