Vaginal versus caesarean delivery in fetal macrosomia-a retrospective cohort study

Abstract

Objective: The aims of this study were to determine the incidence of macrosomic births over a 5-year period and to examine the childbirth complications for both mother and newborn.

Patients and methods: During the study period there were a total of 16,126 deliveries, of which 1905 were macrosomic fetuses (defined as those with a birthweight of 4000 g or more). Data on the course of pregnancy and childbirth were collected from existing maternal and peripartum medical records. Patients were divided into two groups: those who delivered vaginally and those who delivered by caesarean section. The groups were compared in terms of obstetric, fetal, and neonatal data as well as perinatal outcomes.

Results: We included 1905 women in the study, 1286 (67.5%) with vaginal delivery and 619 (32.4%) with caesarean section. Primiparous women more frequently delivered by caesarean section, whereas multiparous women more commonly delivered vaginally (p < 0.00001). Male fetuses were significantly more prevalent in both examined groups. Risk factors for fetal macrosomia, such as gestational diabetes, maternal obesity, pregnancy-induced hypertension, polyhydramnios, and multiparity, were significantly more prevalent in the group with caesarean section (p < 0.00001). Delivery complications such as dorsoposterior presentation of the fetal head; fetal asphyxia, dystocia, and cephalopelvic disproportion; and uterine rupture were statistically significantly more frequent with caesarean section CONCLUSION: Our data show that caesarean deliveries for fetal macrosomia were associated with more maternal and neonatal complications than vaginal deliveries.

Keywords: Diabetes gestational; Labor; Perinatal outcome; Uterine hemorrhage; Uterine rupture.