Abstract
Introduction Foetal macrosomia is associated with various obstetrical complications and is a common
reason for inductions and primary or secondary Caesarean sections. The objective of
this study is the generation of descriptive data on the mode of delivery and on maternal
and foetal complications in the case of foetal macrosomia. The causes and consequences
of foetal macrosomia as well as the rate of shoulder dystocia are examined in relation
to the severity of the macrosomia.
Patients The study investigated all singleton births ≥ 37 + 0 weeks of pregnancy with a birth
weight ≥ 4000 g at the Charité University Medicine Berlin (Campus Mitte 2001 – 2017,
Campus Virchow Klinikum 2014 – 2017).
Results 2277 consecutive newborns (birth weight 4000 – 4499 g [88%], 4500 – 4999 g [11%],
≥ 5000 g [1%]) were included. Maternal obesity and gestational diabetes were more
common in the case of newborns weighing ≥ 4500 g than newborns weighing 4000 – 4499 g
(p = 0.001 and p < 0.001). Women with newborns ≥ 5000 g were more often ≥ 40 years
of age (p = 0.020) and multipara (p = 0.025). The mode of delivery was spontaneous
in 60% of cases, vaginal-surgical in 9%, per primary section in 14% and per secondary
section in 17%. With a birth weight ≥ 4500 g, a vaginal delivery was more rare (p < 0.001)
and the rate of secondary sections was increased (p = 0.011). Women with newborns
≥ 4500 g suffered increased blood loss more frequently (p = 0.029). There was no significant
difference with regard to the rate of episiotomies or serious birth injuries. Shoulder
dystocia occurred more frequently at a birth weight of ≥ 4500 g (5 vs. 0.9%, p = 0.000).
Perinatal acidosis occurred in 2% of newborns without significant differences between
the groups. Newborns ≥ 4500 g were transferred to neonatology more frequently (p < 0.001).
Conclusion An increased birth weight is associated with an increased maternal risk and an increased
rate of primary and secondary sections as well as shoulder dystocia; no differences
in the perinatal outcome between newborns with a birth weight of 4000 – 4499 g and
≥ 4500 g were seen. In our collective, a comparably low incidence of shoulder dystocia
was seen. In the literature, the frequency is indicated with a large range (1.9 – 10%
at 4000 – 4499 g, 2.5 – 20% at 4500 – 5000 g and 10 – 20% at ≥ 5000 g). One possible
cause for the low rate could be the equally low prevalence of gestational diabetes
in our collective. A risk stratification of the pregnant women (e.g. avoidance of
vacuum extraction, taking gestational diabetes into account during delivery planning)
is crucial. If macrosomia is presumed, it is recommended that delivery take place
at a perinatal centre in the presence of a specialist physician, due to the increased
incidence of foetal and maternal complications.
Key words
foetal macrosomia - shoulder dystocia - gestational diabetes
