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Macrosomia

A Proposed Indication for Primary Cesarean Section

From the Department of Obstetrics and Gynecology at the Kaiser- Permanente Medical Center, Los Angeles, California

Abstract

Fetal macrosomia (birthweight equal to or in excess of 4500 g) in a study of 110 affected infants was associated with excessive maternal weight, prolonged gestation, white race, multiparity, maternal diabetes, male fetus, and a previous macrosomic infant. The two most common obstetric complications associated with fetal macrosomia were postpartum hemorrhage and shoulder dystocia. One-minute Apgar score was <7 in 10.9% of the macrosomic infants, in contrast to 6.3% for the smaller infants studied as controls. The low fetal mortality rate (1.8%) was attributed to a 22.5% cesarean rate for the macrosomia group. Even more frequent use of abdominal delivery might further reduce obstetric and neonatal complications for macrosomic infants.