[Analysis of labour and perinatal complications in case of foetus weight over 4000 g].

The fetal macrosomia occurs in 3-15% pregnancies. It is recognized when foetus weight exceeds 4000 g in any period of pregnancy. Macrosomia can also be determined in case of foetus weight over 90 percentyl for the appropriate pregnancy period. The most detrimental foetal complications of macrosomia are: shoulder dystocia with Erb's brachial palsy, facial nerve palsy, clavicular and humeral bone fracture. The attempts in order to eliminate these complications lead to increase in the number of caesarean sections and labour inductions. Clinical examination and assessment of risk factors as well as ultrasonographic examination cannot exclude or confirm the possibility of macrosomia with sufficient specificity and sensitivity. On the other hand it is well known that delivery of macrosomic foetus is not always associated with perinatal complications. The aim of the study was to assess the risk of perinatal complication in foetuses with large birth weight.

METHODS

In case-control study the data from medical records of 652 newborns with birth weight over 4000 g were analysed. Only single born at term foetuses in cephalic presentation were included into the analysis.

RESULTS

The Erb's brachial palsy, clavicular bone fracture, shoulder dystocia and convulsions in newborn were significantly associated with excessive fetal weight. Shoulder dystocia, clavicular bone fracture and brachial palsy were more frequent in group of newborns with birth weight over 4500 g. The frequency of brachial dystocia and its complications (clavicular bone fracture and Erb's brachial palsy) were significantly connected with the use of VE.

CONCLUSIONS

Significant increase in the frequency of perinatal complications in foetuses with birth weight over 4500 g indicates the necessity of considering caesarean section as a favourable mode of delivery.