123 Obstetric Management of Fetal Macrosomia in Non Diabetic Patients

Abstract

OBJECTIVE: We evaluated the obstetric management of fetal macrosomia in the physiologic pregnancy and the role of several maternal (age,weight,gestational age at delivery,gain during pregnancy) and fetal (gender,evaluation by ultrasounds of fetal weight) parameters on the maternal (type of delivery,induction of labor,episiotomy) and fetal (birth weight,Apgar-score at birth) outcome. MATERIAL AND METHODS We investigated 5,062 pregnancies in 5 years (2000–2004) of whom 303 were classified as 'macrosomia' by ultrasounds. RESULTS the incidence of fetal macrosomia does not change throughout the period evaluated.The 93% of pregnant women was Italian,5% Extra-community and 2% European. The fetal macrosomia was more frequent in male than female (9,52% vs. 5,17%) with high incidence of cesarean deliveries (25,39% vs. 17,34%).The fetal weight is directly correlated with parity (r=0,88) and indirectly with maternal age (r=0,91);while the maternal weight is not directly correlated with fetal weight but it depends on maternal weight gain during pregnancy (r= 0,99) except when the fetal weight was like or more than 4,500 grams. In this group of patients the highest incidence of cesarean sections and the lowest values of Apgar-score was found. The fetal macrosomia is the frequent indication of elective cesarean delivery. Our data demonstrate a significative decrease of cesarean delivery with an increase of vaginal delivery with episiotomy in fetal macrosomia. We have not found any case of shoulder dystocia. CONCLUSIONS in the obstetric mangement of fetal macrosomia in physiologic pregnancy we don't evaluate only the fetal weight but several parameters independently to ultrasound evaluation of fetal weight.