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Which way is better to deliver the very heavy baby: mode of delivery, maternal and neonatal outcome

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Currently there are no existing data regarding the maternal and neonatal outcomes for nulliparous women delivering neonates with birthweight above 4500 g. We aim to evaluate birth outcome among these subset of parturients.

Methods

A retrospective study of nulliparous delivering a singleton fetus weighing  ≥ 4500 g in two tertiary medical centers between 2007 and 2018. Women who chose to undergo a trial of labor (TOL) were compared to those who underwent elective cesarean delivery (CD).

Results

Overall, 121 women were included. Seventy eight (65.4%) women elected a TOL while 43 (34.6%) had elective CD. Of women who chose TOL, 46 (59%) delivered with unassisted vaginal delivery, 28 (36%) by intrapartum CD, and 4 (5%) by assisted vaginal delivery, reaching TOL success rate of 64% (50/78). The rates of shoulder dystocia and anal sphincter injury in vaginal deliveries were 5/50 (10%) and 2/50 (4%) respectively. Successful TOL was negatively associated with the presence of gestational diabetes [5 (18%) vs. 0 (0%), OR 0.8 (95% CI 0.7–0.9), p = 0.005], and was positively associated with maternal height (median 170 cm vs. 165 cm, p = 0.002), epidural analgesia [42 (84%) vs. 16 (57%), OR 3.5 (95% CI 1.2–9.8), p = 0.009] and spontaneous onset of labor (38 (76%) vs. 10 (36%), OR 5.7 (95% CI 2.1–15.6), p = 0.001. Neonates born after TOL were more commonly complicated by meconium aspiration syndrome as compared to no TOL (9 (11%) vs. 0 (0%), OR 1.1 (95% CI 1.04–1.22, p = 0.02). Only maternal height was independently associated with successful TOL (aOR 6.9 (95% CI 1.03–46.3, p = 0.04). Maternal and neonatal adverse composite outcomes were associated with gestational hypertensive disorders (10 (50%) vs. 5 (5%). OR 19.2 (5.5–67.4), p < 0.001) and with delivery before 40 weeks (9 (57%) vs, 86 (82%), OR 3.5 (95% CI 1.2–10.6, p = 0.02), respectively.

Conclusions

Trial of vaginal delivery in nulliparous with fetuses ≥ 4500 g was associated with a high failure rate, with only two thirds of parturients achieving successful vaginal delivery. Nevertheless, neonatal outcomes mostly did not differ according to the mode of delivery. Maternal height was the only factor associated with successful vaginal delivery.

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Abbreviations

CD:

Cesarean delivery

TOL:

Trial of labor

References

  1. American College of Obstetricians and Gynecologistss’ Committee on Practice Bulletins—Obstetrics (2016) Practice Bulletin No. 173: fetal macrosomia. Obstet Gynecol 128:e195–e209

    Article  Google Scholar 

  2. Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ (2017) Births: Final Data for 2015. Natl Vital Stat Rep 66:1

    PubMed  Google Scholar 

  3. Koyanagi A, Zhang J, Dagvadorj A et al (2013) Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet 381:476–483

    Article  Google Scholar 

  4. Boulet SL, Alexander GR, Salihu HM, Pass M (2003) Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am J Obstet Gynecol 188:1372–1378

    Article  Google Scholar 

  5. Nesbitt TS, Gilbert WM, Herrchen B (1998) Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol 179:476–480

    Article  CAS  Google Scholar 

  6. Raio L, Ghezzi F, Di Naro E et al (2003) Perinatal outcome of fetuses with a birth weight greater than 4500 g: an analysis of 3356 cases. Eur J Obstet Gynecol Reprod Biol 109:160–165

    Article  Google Scholar 

  7. Smith GC, Smith MF, McNay MB, Fleming JE (1997) The relation between fetal abdominal circumference and birthweight: findings in 3512 pregnancies. Br J Obstet Gynaecol 104:186–190

    Article  CAS  Google Scholar 

  8. O'Reilly-Green CP, Divon MY (1997) Receiver operating characteristic curves of sonographic estimated fetal weight for prediction of macrosomia in prolonged pregnancies. Ultrasound Obstet Gynecol 9:403–408

    Article  CAS  Google Scholar 

  9. Melamed N, Yogev Y, Meizner I, Mashiach R, Ben-Haroush A (2010) Sonographic prediction of fetal macrosomia: the consequences of false diagnosis. J Ultrasound Med 29:225–230

    Article  Google Scholar 

  10. Benacerraf BR, Gelman R, Frigoletto FD (1988) Sonographically estimated fetal weights: accuracy and limitation. Am J Obstet Gynecol 159:1118–1121

    Article  CAS  Google Scholar 

  11. Delivery of macrosomic fetus—committee opinion

  12. Carpenter MW, Coustan DR (1982) Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 144:768–773

    Article  CAS  Google Scholar 

  13. Politi S, D’emidio L, Cignini P, Giorlandino M, Giorlandino C (2010) Shoulder dystocia: an evidence-based approach. J Prenat Med 4:35–42

    PubMed  PubMed Central  Google Scholar 

  14. Stotland NE, Caughey AB, Breed EM, Escobar GJ (2004) Risk factors and obstetric complications associated with macrosomia. Int J Gynaecol Obstet 87:220–226

    Article  CAS  Google Scholar 

  15. Salomon LJ, Alfirevic Z, Da Silva CF et al (2019) ISUOG practice guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound Obstet Gynecol 53:715–723

    Article  CAS  Google Scholar 

  16. Boulvain M, Senat MV, Perrotin F et al (2015) Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet 385:2600–2605

    Article  Google Scholar 

  17. Menticoglou SM, Manning FA, Morrison I, Harman CR (1992) Must macrosomic fetuses be delivered by a caesarean section? A review of outcome for 786 babies greater than or equal to 4,500 g. Aust N Z J Obstet Gynaecol 32:100–103

    Article  CAS  Google Scholar 

  18. Lipscomb KR, Gregory K, Shaw K (1995) The outcome of macrosomic infants weighing at least 4500 grams: Los Angeles County + University of Southern California experience. Obstet Gynecol 85:558–564

    Article  CAS  Google Scholar 

  19. McFarland MB, Trylovich CG, Langer O (1998) Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern Fetal Med 7:292–295

    CAS  PubMed  Google Scholar 

  20. Bahar AM (1996) Risk factors and fetal outcome in cases of shoulder dystocia compared with normal deliveries of a similar birthweight. Br J Obstet Gynaecol 103:868–872

    Article  CAS  Google Scholar 

  21. Endres L, DeFranco E, Conyac T et al (2015) Association of fetal abdominal-head circumference size difference with shoulder dystocia: a multicenter study. AJP Rep 5:e099–104

    Article  Google Scholar 

  22. Sakala EP, Kaye S, Murray RD, Munson LJ (1990) Epidural analgesia. Effect on the likelihood of a successful trial of labor after cesarean section. J Reprod Med 35:886–890

    CAS  PubMed  Google Scholar 

  23. Okun N, Verma A, Mitchell BF, Flowerdew G (1997) Relative importance of maternal constitutional factors and glucose intolerance of pregnancy in the development of newborn macrosomia. J Matern Fetal Med 6:285–290

    CAS  PubMed  Google Scholar 

  24. Avcı ME, Şanlıkan F, Çelik M, Avcı A, Kocaer M, Göçmen A (2015) Effects of maternal obesity on antenatal, perinatal and neonatal outcomes. J Matern Fetal Neonatal Med 28:2080–2083

    Article  Google Scholar 

  25. Dargaville PA, Copnell B, Australian, and New Zealand Neonatal Network (2006) The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 117:1712–1721

    Article  Google Scholar 

  26. Hernández C, Little BB, Dax JS, Gilstrap LC, Rosenfeld CR (1993) Prediction of the severity of meconium aspiration syndrome. Am J Obstet Gynecol 169:61–70

    Article  Google Scholar 

  27. Kwawukume EY, Ghosh TS, Wilson JB (1993) Maternal height as a predictor of vaginal delivery. Int J Gynaecol Obstet 41:27–30

    Article  CAS  Google Scholar 

  28. Mogren I, Lindqvist M, Petersson K et al (2018) Maternal height and risk of caesarean section in singleton births in Sweden—a population-based study using data from the Swedish Pregnancy Register 2011 to 2016. PLoS ONE 13:e0198124

    Article  Google Scholar 

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Funding

No external funding was used in this conduct of this study. GL, RM and AR reviewed the literature and wrote the paper. YY, SY and DM performed the procedures and collected the data. All authors read and approved the final manuscript.

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Author notes

  1. Gabriel Levin and Raanan Meyer have equally contributed to this study.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel

    Gabriel Levin, Simcha Yagel, Mankuta David & Amihai Rottenstreich

  2. The Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel

    Raanan Meyer & Yoav Yinon

  3. The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Yoav Yinon

Authors
  1. Gabriel Levin
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  2. Raanan Meyer
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  3. Simcha Yagel
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  4. Mankuta David
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  5. Yoav Yinon
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  6. Amihai Rottenstreich
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All authors contributed to the manuscript.

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Correspondence to Gabriel Levin.

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Authors declare that they have no conflict of interest.

Ethical approval

For this type of study formal consent is not required and was waived by the institutional review board approval. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Levin, G., Meyer, R., Yagel, S. et al. Which way is better to deliver the very heavy baby: mode of delivery, maternal and neonatal outcome. Arch Gynecol Obstet 301, 941–948 (2020). https://doi.org/10.1007/s00404-020-05474-w

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  • DOI: https://doi.org/10.1007/s00404-020-05474-w

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