Indication of caesarean section in the childbirth of a macrosome in a Level 2 Health Center in Dakar

Abstract

Objectives: To determine the factors influencing the mode of delivery in case of fetal macrosomia. Materials and Methods: That was a retrospective, descriptive and analytical study carried out from October 1st 2010 to March 31st 2013 at the maternity of Gaspard Kamara Health Center in Dakar. A multivariate analysis using logistic regression was used to determine the factors which influence the mode of delivery in case of fetal macrosomia. Results: We collected 333 delivery records of macrosome on 10639 registered births, a rate of 3.1%. Two hundred and fifteen (215) patients met the inclusion criteria. The labor’s test was performed in 55.3% of patients with a failure rate of 15.1%. Caesarean section was performed in 22.8% of patients. The main indications were: acute fetal distress (36.7%), the fetal-pelvic disproportion (26.5%), premature rupture of membranes (12.2%), the extended labor (10.2%), and the lack of engagement (10.2%). All newborns had Apgar score in the fifth minute greater than or equal to 7. The factors that influenced the type of delivery were: fetal weight above 4300 g (p=0.007), nulliparity (p<0.001) and a uterine height upper than 34 cm (p=0.034). Conclusion: In case of fetal macrosomia, fetal weight above 4300 g, nulliparity and the upper uterine height 34 cm are associated with a higher incidence of caesarean delivery.