Abstract
Setting: Ipswich Hospital NHS Trust Design: Retrospective observational Time period: February 2016-August 2016 We identified singleton babies with birth weight of >90th centile on customised growth chart, diabetic pregnancies excluded. We found number of pregnancies induced for suspected fetal macrosomia. Data was collected from Evolve and patients' notes. We stratified data into two groups i.e. pregnancies with macrocosmic babies antenatally (known) and other where macrosomia was detected (unknown) after birth. In total 212 women, macrosomia was suspected in 139 (known) antenatally and 73 (unknown). Majority (98%) in Known group had scan >34 weeks. More women were with BMI>35 (18% vs 8%) and primiparous (42% vs 19%) in known group. Mean values for age, parity and BMI were similar. Induction of labour (IOL) in unknown group was 22% (RR 2.56 [1.62, 4.04]) vs known group (56%). The average birth weight in unknown group was 4201g +/-387 gms. There was no statistical difference in incidence of PPH (3.7% vs 7%, RR-2.36 [0.52, 10.65]) and 3-4th degree perineal tears (5.6% vs 5.5%, RR 1.05 [0.27, 4.08]). Emergency c-section rate was 18% in known vs 11% in unknown group. Instrumental delivery rate was 19% (known) vs 15% (unknown) group. More trend for shoulder dystocia was seen in the unknown group (7.5% vs 4.4%). The NNU admission rate was 3.7% in unknown group and 12% in known group (RR4.46 [1.06, 18.79]); all except one baby in the known group were delivered after 38 weeks. Results showed that known fetal macrosomia lead to more intervention. Though shoulder dystocia occurred more in unknown group but neonatal admissions were significantly less. Therefore, increase in intervention rates and consequences should be balanced against risk of shoulder dystocia. Whether a policy of actively screening for macrosomia should be pursued, is debatable as ultrasound could only correctly identify 57% babies >90th centile and 33% babies more than 95th centile.
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