Determination of the Intervention Strategies for the Prevention of Fetal Macrosomia Dependent Cesarean Sections in Nigeria

Ute Inegbenebor

doi:10.12691/ajphr-5-3-2

Abstract

Background: Subsequent to the rising cesarean section rates worldwide over the past three decades, this study was done to determine the risk factors that predispose to fetal macrosomia with the aim of determining the intervention strategies for preventing fetal macrosomia dependent cesarean sections in Nigeria. Subjects and Methods: A record review of the birth weights of 2410 babies delivered in St Philomenaâs Hospital, a survey of the nutritional habits of 75 mothers of macrosomic babies attending postnatal clinic within the study period, and an assessment of the level of awarenessâ of the fasting blood glucose status of 75 mothers of macrosomic babies and 330 pregnant women with interviewer administered questionnaire were done. Results: The prevalence rate for fetal macrosomia in St Philomenaâs Hospital was 8.4% during the study period. Cesarean section rate among women with fetal macrosomia was 39.2% compared to a rate of 18% in women who gave birth to babies with normal birth weight. It was also found that most pregnant women and mothers of macrosomic babies were not aware of their fasting blood glucose status. Majority of mothers of macrosomic babies preferred high glycemic index diets and also consumed sugary beverages on daily basis. Conclusion: Fetal macrosomia is a preventable outcome of pregnancy in the presence of moderate dietary restriction, low glycemic index diets as well as the inclusion of dietary fiber in the diet of pregnant women. Furthermore, a lower incidence of fetal macrosomia is capable of reducing cesarean section rates in Nigeria.

Highlights

Cesarean section rates have escalated in all parts of the world in the last thirty years or more
Cesarean section rates have risen to almost 50% in China, [3] 50% in Brazil, [4] 32% in U.S.A, [5] and variable rates of 14.3-35.5% in the various geopolitical regions of Nigeria [6,7,8,9,10]
Fetal macrosomia may become an important factor in increasing cesarean section rates especially when obesity is becoming a pandemic

Summary

Introduction

Cesarean section rates have escalated in all parts of the world in the last thirty years or more. Cesarean section rates have increased astronomically in the past thirty years for several reasons These include non-medical factors, [11] fear of litigation, [12] perceived safety of cesarean section in comparison to vaginal birth [3] and assurance of survival for precious baby, [13] pressure from patients and family members, [11] financial gain [14,15] and medical factors such as poor management, and lack of knowledge of partograph and lack of knowledge of the use of forceps and vacuum extractor. Benin City has several public and private hospitals, among which, are 2 state government owned tertiary hospitals, a federal government owned tertiary (teaching hospital) and 2 prominent missionary hospitals Each of these hospitals has facilities for maternal health activities of Antenatal care, Clean and Safe Delivery, Post Natal Care and Family planning. This study was conducted in St Philomena’s Hospital in Benin City, Nigeria

Results

Discussion

Conclusion