Fetal macrosomia greater than or equal to 4000 grams. Comparing maternal and neonatal outcomes in diabetic and nondiabetic women

Department of Obstetrics and Gynecology, Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia.
Saudi medical journal (Impact Factor: 0.59). 10/2008; 29(10):1463-9.
Source: PubMed


To compare maternal and neonatal outcomes of fetal macrosomia in diabetic and nondiabetic women.
A retrospective case-control study was conducted at Riyadh Military Hospital, Riyadh, Kingdom of Saudi Arabia from January 2004 to December 2006. A total of 766 macrosomic newborns met the inclusion criteria. We compared maternal and neonatal characteristics and outcomes between diabetic (group 1, n=207) and nondiabetic (group 2, n=559) women.
There were significantly more macrosomic newborns in nondiabetic women; 73% versus 27% in diabetic women, p=0.0001. Cesarean deliveries were significantly higher in diabetic women compared to nondiabetic women (30.4% versus 19.5%, p=0.002). There were no significant differences between either group in total maternal morbidity (12.6% versus 14.1%, p=0.7). There were significantly more severe cases of shoulder dystocia occurring in newborns of diabetic women compared to nondiabetic women (1.9% versus 0.2%, p=0.03).
Elective cesarean delivery for estimated fetal weight > or =4500g for nondiabetic women and > or =4250 g for diabetic women may avoid severe shoulder dystocia without increasing maternal morbidity rates.

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    • "The highest reported prevalence is 20% in Nordic countries,[2] while 1.5% of neonates in the USA have a birth weight of ≥4.5 kg.[10] A previous study conducted in KSA from 2004 through 2006 reported a prevalence of 5.6% using the same birth weight definition,[11] which is greater than the rate in our report. A decline in the fetal macrosomia rate is supported by data from the National Vital Statistics; the USA has shown a significant, steady decline in the rate of fetal macrosomia using the same weight definition for macrosomia.[12] "
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    ABSTRACT: Fetal macrosomia remains a considerable challenge in current obstetrics due to the fetal and maternal complications associated with this condition. This study was designed to determine the prevalence of fetal macrosomia and associated fetal and maternal morbidity and mortality in the Al Qassim Region of Saudi Arabia. This register-based study was conducted from January 1, 2011 through December 30, 2011 at the Maternity and Child Hospital, Qassim, Saudi Arabia. Macrosomia was defined as birth weight of 4 kg or greater. Malformed babies and those born dead were excluded. The total number of babies delivered was 9241; of these, 418 were macrosomic. Thus, the prevalence of fetal macrosomia was 4.5%. The most common maternal complications were postpartum hemorrhage (5 cases, 1.2%), perineal tear (7 cases, 1.7%), cervical lacerations (3 cases, 0.7%), and shoulder dystocia (40 cases, 9.6%) that resulted in 4 cases of Erb's palsy (0.96%), and 6 cases of bone fractures (1.4%). The rate of cesarean section among women delivering macrosomic babies was 47.6% (199), while 52.4% (219) delivered vaginally. Despite extensive efforts to reduce fetal and maternal complications associated with macrosomia, considerable fetal and maternal morbidity remain associated with this condition.
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    ABSTRACT: Aim: To evaluate the effect of delivery route on birth complications and related costs in fetal macrosomia (>4000 g). Materials and methods: Patient and newborn hospital records of 365 macrosomic deliveries (>= 4000 g) were retrospectively analyzed. Of these deliveries, 189 newborns weighed between 4000 and 4249 g (Group I), and 176 were between 4250 and 4500 g (Group II). The effects of mode of delivery on birth complications were evaluated and a simple cost-effectiveness analysis was performed. Results: There was no statistical difference between the 2 groups concerning birth complications, except dystocia and episiotomy hematoma. The rate of dystocia was found to be significantly higher in Group II than in Group 1(14.1% versus 3.8%, respectively; P = 0.040). Similarly, episiotomy hematoma was found to be significantly higher in Group II than in Group 1(18.8% versus 3.8%, respectively; P = 0.004). As opposed to similar rates of serious and permanent complications, mild or moderate temporary maternal and fetal complications were seen to be higher in vaginal births of infants weighing more than 4250 g (P = 0.001 and P = 0.024, respectively). In macrosomia, the total cost of a cesarean. section (OS) was almost 2 times higher than the cost of a vaginal delivery per patient (937 Turkish liras versus 491 Turkish liras, respectively). Conclusion: C/S was not related with favorable maternal or newborn outcomes, and it was not a cost-effective option in patients with fetal birth weights between 4250 and 4500 g.
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    ABSTRACT: To estimate and compare the obstetric outcome of fetal macrosomia in both diabetic and non-diabetic mothers as challenges in obstetrics practice Karachi, Pakistan. Study Design: comparative cross sectional, Study duration: From June 2008-May 2009, Study population: All singleton pregnant women, Sample size: 229. Neonates with birth weight of 3,500 gms or greater born to diabetic and non-diabetic mother. Babies with 3,500 gms birth weight and more were considered as macrosomic. The major outcome measures were obstetrics outcome: live births, perinatal mortality, mode of delivery and APGAR scores of both groups. We compared demographic, obstetric and neonatal outcomes on diabetic & non-diabetic mothers delivering macrosomic babies. Data were entered and analyzed using SPSS windows version 15. Significance of difference was calculated using t test, Chi square test as applicable. There were 72 diabetic and 157 non-diabetic pregnant women. Uncomplicated diabetic and non-diabetic women of single index pregnancy had age range of 19–35 years. Overall incidence of macrosomia ( ≥ 3,500 gms) in this study was 72(31.4%). In this study there were significantly more macrosomic newborns in diabetic women; (52.8%) compared to (47.2%). Fetal macrosomia in our study was 31.4% in both diabetic and non-diabetic mothers. The obstetric challenges of diagnosis and management of fetal macrosomia in low resource country like Pakistan require screening for macrosomia as an integral part of antenatal care.
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