Vaginal versus caesarean delivery in fetal macrosomia-a retrospective cohort study

The aims of this study were to determine the incidence of macrosomic births over a 5-year period and to examine the childbirth complications for both mother and newborn.

During the study period there were a total of 16,126 deliveries, of which 1905 were macrosomic fetuses (defined as those with a birthweight of 4000 g or more). Data on the course of pregnancy and childbirth were collected from existing maternal and peripartum medical records. Patients were divided into two groups: those who delivered vaginally and those who delivered by caesarean section. The groups were compared in terms of obstetric, fetal, and neonatal data as well as perinatal outcomes.

We included 1905 women in the study, 1286 (67.5%) with vaginal delivery and 619 (32.4%) with caesarean section. Primiparous women more frequently delivered by caesarean section, whereas multiparous women more commonly delivered vaginally (p < 0.00001). Male fetuses were significantly more prevalent in both examined groups. Risk factors for fetal macrosomia, such as gestational diabetes, maternal obesity, pregnancy-induced hypertension, polyhydramnios, and multiparity, were significantly more prevalent in the group with caesarean section (p < 0.00001). Delivery complications such as dorsoposterior presentation of the fetal head; fetal asphyxia, dystocia, and cephalopelvic disproportion; and uterine rupture were statistically significantly more frequent with caesarean section CONCLUSION: Our data show that caesarean deliveries for fetal macrosomia were associated with more maternal and neonatal complications than vaginal deliveries.