Abstract

The management of fetal macrosomia diagnosed antenatally is quite challenging to the obstetricians. The authors retrospectively reviewed charts of singleton pregnancies weighing 5000 g and over delivered between 2004 and 2008.This was to determine the maternal and neonatal morbidity and also whether lack of consistent management in two units influences the outcome. Over 5 year period there were 173 births out of 76 699 deliveries that weighed more than 5000 g. This gives incidence of 0.22%. The onset of labour was spontaneous in 52 (30.0%) cases, 69 (40%) were inductions and 52 (30.0%) were elective caesarean sections. Of 121 planned vaginal deliveries, 59 (48.76%) were spontaneous vaginal deliveries, 22 (18.8%) were operative vaginal deliveries and 36 (29.75%) were emergency caesarean sections. Only 104 cases that had ultrasound recorded estimated fetal weight (EFW). 84(48.5%) cases had EFW >95%, 29 had vaginal deliveries, 20 had emergency caesarean and 35 elective caesarean section contributing 52.8% to caesarean section rate. Of this group, 3 cases of shoulder dystocia (3.57%), 10 (11.9%) cases of post partum haemorrhage (PPH). 24 (13.87%) cases EFW<95%, nine had vaginal deliveries, nine emergency and six elective caesarean section. Of this group 1 case had shoulder dystocia (0.57%) and nine (5.2%) cases of PPH. The authors recommend when there is EFW >5000 g there is increase risk of caesarean section rate, Induction for fetal macrosomia alone did not improve the outcome. Variations in the care provided by different consultants did not have any influence on the outcome.