Fetus-Placenta-Newborn
Effects 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

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Abstract

Objective: The aim of this study was to examine the effects of a policy of elective cesarean delivery for suspected fetal macrosomia on the incidence of brachial palsy and on the cesarean delivery rate. Study Design: We performed a retrospective assessment of a policy that recommends cesarean delivery for macrosomia (fetal weight ≥4500 g). Fetal weight was estimated by palpation, and ultrasonographic weight estimation was carried out whenever macrosomia was suspected. Results: During the 4 years of the study 16,416 deliveries resulted in 133 infants with macrosomia (0.8%). Macrosomia was suspected in 47 cases and confirmed by birth weight in 21 (45%). Antenatal estimation of fetal weight was carried out for 115 of the fetuses with macrosomia (86%). Macrosomia was correctly predicted in 21 of 115 cases (18.3%). Thirteen infants with undiagnosed macrosomia were delivered by emergency cesarean procedures, and 99 were delivered vaginally. Three infants with macrosomia (3%) and 14 infants without macrosomia (0.1%) sustained brachial plexus injury. Our policy prevented at most a single case of brachial palsy, and it contributed 0.16% to our cesarean delivery rate. Conclusions: A policy of elective cesarean delivery in cases of suspected fetal macrosomia had an insignificant effect on the incidence of brachial plexus injury. Its contribution to the rate of cesarean delivery was also small. (Am J Obstet Gynecol 2000;183:1296-300.)

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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.

. Flow chart of study. BWT, Birth weight; CS, cesarean delivery; VD, vaginal delivery; BPI, brachial plexus injury.

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.

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