Document Detail

Obstetric outcome of extreme macrosomia.
MedLine Citation:
PMID:  15937604     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To determine the effect of extreme macrosomia on perinatal outcome. METHODS: We conducted a retrospective review of all deliveries with birth weight > or = 5000 g in a tertiary centre from 1986 to 2000 and analyzed the method of delivery and perinatal outcome. RESULTS: Extreme macrosomia (birth weight > or = 5000 g) was coded in 111 deliveries. There were 62 deliveries by Caesarean section (CS) (25 in labour and 37 elective). The 49 vaginal deliveries were complicated by 10 (20%) cases of shoulder dystocia and 3 (6%) of Erb's palsy. Permanent Erb's palsy was noted in only 1 of these 3 cases. Shoulder dystocia was associated with use of oxytocin and instrumental deliveries. CONCLUSION: Implementing the 2002 guidelines from the American College of Obstetricians and Gynecologists (that is, recommending Caesarean delivery of fetuses with an estimated weight of at least 5000 g) would have a negligible effect on the CS rate while eliminating 10 cases of shoulder dystocia in 49 births. A policy eliminating the use of oxytocin and instrumental deliveries would have prevented most birth traumas in this group. Unfortunately, this high-risk group is difficult to identify in the antepartum period, complicating the implementation of these guidelines and probably leading to higher rates of CS. In addition, the effect of endorsing such a policy on overall neonatal and maternal morbidity is minimal, because most morbidity occurs in newborns weighing less than 4000 g.
Sahar Alsunnari; Howard Berger; Mathew Sermer; Gareth Seaward; Edmond Kelly; Dan Farine
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC     Volume:  27     ISSN:  1701-2163     ISO Abbreviation:  J Obstet Gynaecol Can     Publication Date:  2005 Apr 
Date Detail:
Created Date:  2005-06-06     Completed Date:  2005-09-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101126664     Medline TA:  J Obstet Gynaecol Can     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  323-8     Citation Subset:  IM    
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto ON.
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MeSH Terms
Birth Injuries / epidemiology
Brachial Plexus Neuropathies / epidemiology
Cesarean Section / statistics & numerical data
Delivery, Obstetric / statistics & numerical data
Dystocia / epidemiology
Extraction, Obstetrical / statistics & numerical data
Fetal Macrosomia / epidemiology*
Infant, Newborn
Infant, Newborn, Diseases / epidemiology
Labor Stage, First
Labor Stage, Second
Length of Stay / statistics & numerical data
Ontario / epidemiology
Retrospective Studies
Surgical Procedures, Elective / statistics & numerical data
Reg. No./Substance:
0/Oxytocics; 50-56-6/Oxytocin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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