Mode of delivery and birth outcomes of macrosomic infants

Abstract

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.

What is the value of ultrasound soft tissue measurements in the prediction of abnormal fetal growth?

“…Fetal macrosomia significantly increases the rates of instrumental vaginal delivery, caesarean section, perineal trauma and postpartum haemorrhage (Turner et al 1990). From a fetal perspective, macrosomia increases the risk of shoulder dystocia, intrapartum death, admissions to the neonatal unit, and newborn metabolic problems, in particular, hypoglycaemia (Boulet et al 2005). Macrosomic infants are also predisposed to childhood obesity and to increased morbidity in later life, including insulin resistance, hypertension and diabetes (Barker et al 1993;Plagemann et al 1997).…”

Excessive weight gain during pregnancy and risk of macrosomia: a meta-analysis

“…The long-term risks include childhood obesity, overweight, diabetes, metabolic syndrome and cancer later in life [5][6][7][8]. Moreover, giving birth to macrosomic infants is associated with a higher risk of maternal complications including hemorrhage, infection, preeclampsia, perinatal mortality, prolonged labor, operative deliveries and perineal injuries [9][10][11]. The risks are even greater for babies with birth weights exceeding 4500 g [12].…”

Estimativa de peso ao nascimento utilizando a ultrassonografia bidimensional e tridimensional

“…Tanto a macrossomia 1,2 quanto a restrição de crescimento fetal (RCF) 3,4 estão relacionadas a um risco aumentado de morbidade e mortalidade perinatais, inclusive com consequências pós-natais tardias.…”