Fetal macrosomia: Obstetric outcome of 311 cases in UNTH, Enugu, Nigeria

Background: In modern obstetrics, fetal macrosomia is a major contributor to obstetric morbidity. It is an important cause of perinatal morbidity and mortality. Aim: This study aims to determine the maternal characteristics, fetal and neonatal complications associated with fetal macrosomia, and its contribution to obstetric morbidity in Enugu, Nigeria. Materials and Methods: This was a 3-year retrospective study carried out from 1st January 2005 to 31st December 2007. Results: There were a total of 434 cases of fetal macrosomia out of 5,365 deliveries. The incidence of fetal macrosomia was 8.1%. Only 311 case notes (71.6%) were available for analysis. Statistical analysis showed that mothers of macrosomic newborns were older (30.6 +/- 5.6 vs. 27.4 +/- 4.74; P = 0.001), higher parity (4.1 +/- 2.7 vs. 2.5 +/- 1.07; P = 0.001), and weighed more at term (89.13 +/- 6.17 kg vs. 71.43 +/- 5.27 kg; P = 0.002). The study group had more mothers with previous history of macrosomic babies (39.5% vs. 12.5%), diabetes (3.2% vs. 1%), significant higher cesarian section rate (27.3% vs. 11.9%, P = 0.001), and operative vaginal delivery (3.6% vs. 1%; P = 0.001) compared with the control. There was male dominance in the study group compared with the control (63% vs. 56.3%; P = 0.001), higher risk of fetal asphyxia (P = 0.001), and greater mean birth weight (3.6 +/- 1.2 kg vs. 3.2 +/- 0.6 kg; P = 0.002). There were 7 (2.3%) cases of shoulder dystocia in the macrosomic group and none in the non-macrosomic group. The stillbirth rate (3.2/1000) was the same in both study group and control. This was not statistically significant (P = 0.124). Conclusion: The precise determination of fetal weight is only done at delivery. Clinical and ultrasound determination of fetal weight are highly imprecise especially at the third trimester. The route of delivery should therefore be individualized.