Fetus-Placenta-NewbornEffects of a policy of elective cesarean delivery in cases of suspected fetal macrosomia on the incidence of brachial plexus injury and the rate of cesarean delivery☆
Section snippets
Methods
We performed a retrospective appraisal of a policy that was implemented in our department in 1995 that recommended cesarean delivery for suspected macrosomia, which was defined as an estimated fetal weight of ≥4500 g. Parturients with fetuses with presumed macrosomia were counseled regarding the risk for shoulder dystocia and the risk for brachial plexus injury. Our institution is a teaching hospital that mainly serves a middle-class urban population. Certified midwives conduct uncomplicated
Results
Between April 1, 1995, and March 31, 1999, there were 16,416 deliveries at our institution. During that period 133 (0.8%) infants with macrosomia meeting the inclusion criteria were delivered. Fig 1 shows a flow chart of the study.Fetal macrosomia was suspected antenatally in 47 parturients, and the diagnosis was confirmed by birth weight in 21 of these cases (45%). Among the 47
Comment
This study was undertaken to evaluate a policy of elective cesarean delivery in cases of fetal macrosomia. It is important to realize that our data reflect a real-life situation in a busy delivery room rather than a study setup. Likewise, because routine ultrasonographic estimation of fetal weight for all parturients admitted in labor is impractical, we used fetal weight estimation by palpation as a screening method, with ultrasonography reserved for cases of clinically suspected macrosomia.
The
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