Influence of Foetal Macrosomia on the Neonatal and Maternal Birth Outcome

Abstract

Introduction Foetal macrosomia is associated with various obstetrical complications and is a common reason for inductions and primary or secondary Caesarean sections. The objective of this study is the generation of descriptive data on the mode of delivery and on maternal and foetal complications in the case of foetal macrosomia. The causes and consequences of foetal macrosomia as well as the rate of shoulder dystocia are examined in relation to the severity of the macrosomia. Patients The study investigated all singleton births ≥ 37 + 0 weeks of pregnancy with a birth weight ≥ 4000 g at the Charité University Medicine Berlin (Campus Mitte 2001 – 2017, Campus Virchow Klinikum 2014 – 2017). Results 2277 consecutive newborns (birth weight 4000 – 4499 g [88%], 4500 – 4999 g [11%], ≥ 5000 g [1%]) were included. Maternal obesity and gestational diabetes were more common in the case of newborns weighing ≥ 4500 g than newborns weighing 4000 – 4499 g (p = 0.001 and p < 0.001). Women with newborns ≥ 5000 g were more often ≥ 40 years of age (p = 0.020) and multipara (p = 0.025). The mode of delivery was spontaneous in 60% of cases, vaginal-surgical in 9%, per primary section in 14% and per secondary section in 17%. With a birth weight ≥ 4500 g, a vaginal delivery was more rare (p < 0.001) and the rate of secondary sections was increased (p = 0.011). Women with newborns ≥ 4500 g suffered increased blood loss more frequently (p = 0.029). There was no significant difference with regard to the rate of episiotomies or serious birth injuries. Shoulder dystocia occurred more frequently at a birth weight of ≥ 4500 g (5 vs. 0.9%, p = 0.000). Perinatal acidosis occurred in 2% of newborns without significant differences between the groups. Newborns ≥ 4500 g were transferred to neonatology more frequently (p < 0.001). Conclusion An increased birth weight is associated with an increased maternal risk and an increased rate of primary and secondary sections as well as shoulder dystocia; no differences in the perinatal outcome between newborns with a birth weight of 4000 – 4499 g and ≥ 4500 g were seen. In our collective, a comparably low incidence of shoulder dystocia was seen. In the literature, the frequency is indicated with a large range (1.9 – 10% at 4000 – 4499 g, 2.5 – 20% at 4500 – 5000 g and 10 – 20% at ≥ 5000 g). One possible cause for the low rate could be the equally low prevalence of gestational diabetes in our collective. A risk stratification of the pregnant women (e.g. avoidance of vacuum extraction, taking gestational diabetes into account during delivery planning) is crucial. If macrosomia is presumed, it is recommended that delivery take place at a perinatal centre in the presence of a specialist physician, due to the increased incidence of foetal and maternal complications.

Neonatal Outcome of Macrosomia

“…6,8 However, there are no specific guidelines as of yet to estimate a sonographic weight at or above which elective Caesarean section is recommended. 13 One of the findings of our study report was higher incidence of PIH in macrosomic pregnancies (5.4%) than in AGA pregnancies (4.4%). This hints towards macrosomia to be an important consequence.…”

“…The incidence of complications leading to NICU admission has been found to be higher in macrosomic babies compared to AGA babies. 2,13,14 Similarly, the need for interventions like CPAP and mechanical ventilation for increased respiratory morbidity has been found to be more in macrosomic babies. 6 All these complications may also have been a contributing factor in the increased frequency of neonatal sepsis in macrosomic babies in comparison to AGA babies.…”

Influence of Sonographic Fetal Weight Estimation Inaccuracies in Macrosomia on Perinatal Outcome

“…Ultrasound estimation of fetal weight (EFW) is routinely used in obstetric care, and it influences antenatal management, including the timing and mode of delivery 4 . However, particularly in (suspected) fetal macrosomia, EFW is known to be inaccurate, with potentially severe overestimation and underestimation 5 6 7 8 9 10 11 12 13 14 . Overestimation of fetal weight in (suspected) fetal macrosomia leads to an increase in the CSR 15 16 .…”

ROC Curve Analysis of the Sensitivity and Specificity of Biochemical Detection of Intrahepatic Cholestasis during Pregnancy

“…Increased CG levels will increase the incidence of fetal distress and stillbirth. Monitoring the change in CG levels has important clinical signifi cance for reducing the adverse outcomes of newborns [ 22 ] .…”