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[Delivery of large infants. Management and results of 198 cases]
P Panel1, J B de Meeus, B Yanoulopoulos
1Service de Gynécologie-Obstétrique, CHRU Poitiers, Hôpital Jean-Bernard.
Insights
This study analyzed 198 large fetus deliveries, identifying key risk factors like maternal weight gain and obesity. Nearly 90% of cases had identifiable risk factors, guiding clinical attention for large fetus prediction.
Area of Science:
- Obstetrics and Gynecology
- Perinatology
- Fetal Medicine
Context:
- Large fetus (macrosomia) deliveries pose significant risks to both mother and neonate.
- Understanding risk factors is crucial for effective prenatal management and delivery planning.
- This study examines deliveries of infants weighing 4,000 grams or more.
Purpose:
- To identify and analyze risk factors associated with large fetus deliveries.
- To evaluate the obstetrical and neonatal outcomes in cases of macrosomia.
- To inform clinical practice regarding the prediction and management of large fetuses.
Summary:
- A 3-year study of 198 large fetus deliveries revealed common risk factors including maternal obesity, excessive weight gain, and large uterine height.
- Obstetrical interventions were frequent, with 9.09% Cesarean sections and 23.8% instrumental deliveries.
- Neonatal complications included fractures and nerve palsies, while maternal morbidity involved hemorrhage and trauma, with no maternal mortality.
Impact:
- Identified risk factors can aid in proactive screening and management of pregnancies at risk for macrosomia.
- Findings highlight the increased need for specialized care and potential interventions during labor and delivery.
- This research contributes to improved understanding of macrosomia's impact on maternal and neonatal health outcomes.
Abstract:
We have studied the deliveries of 198 large fetuses over a period of 3 years between 1st January 1987 and 31st December 1989 in the University Hospital of Poitiers. By large fetus we mean the delivery of a child of 4,000 grammes or more. This occurs in 4.5% of deliveries. The following risk factors are present either singularly or together with others: previous delivery of a large child (12.6%), a previous history of pregnancy diabetes or its absence (2.5%), an increase of weight during pregnancy of more than 15 kgs (46.8%), obesity before the onset pregnancy (19.7%), the height of the uterus equal to or above 35 cms (75.8%). These factors were found in nearly 90% of the patients. Their presence should make one look for a large fetus. The obstetrical results were as follows: 18 ceasareans were carried out (9.09%); instrumental delivery was necessary in 43 cases (23.8%); there were 17 cases of shoulder dystocia treated by obstetrical manoeuvres (9.5%). There were therefore 122 vaginal deliveries without any interference (61%). Neonatal complications were: one lost because of malformation (0.5%), serious morbidity in 30 deliveries (15.15%); 16 fractures of the clavicle and two cases of brachial plexus paralysis of which one persisted, two facial palsies which recovered, six infections, three cases of hypoglycaemia and one serious fetal distress which recovered without any sequelae. Maternal complications were: no mortality, serious morbidity in 26 women (14.1%), 9 haemorrhages at delivery, 9 cases of trauma of the perineum, 6 infections, and 2 haematomata in the episiotomy wound.(ABSTRACT TRUNCATED AT 250 WORDS)