Outcome of second delivery after prior macrosomic infant in women with normal glucose tolerance.
OBJECTIVE
Our aim was to estimate the obstetric outcome of second delivery in women with normal glucose tolerance whose first fetus was macrosomic (fetal weight >/= 4,500 g).


METHODS
Primiparas delivering a macrosomic infant during the years 1997-2000 were identified from a hospital computer database, and the obstetric outcome of a second delivery was analyzed up until June 2003. A control group (birth weight 3,000-3,500 g) served for comparison.


RESULTS
Among 13,020 first pregnancies, 301 (2.3%) were macrosomic. A similar proportion in the macrosomic group, 156 of 301 (52%), and control group, 171 of 300 (57%), returned for second delivery (P = .252). Compared with controls, first macrosomic deliveries were characterized by higher rates of operative delivery, anal sphincter injury, and shoulder dystocia. At second delivery, 32% of neonates in the macrosomic group and 0.3% in the control group weighed 4,500 g or more (P < .001). More prelabor cesareans were performed in the macrosomic group compared with controls (27 of 156, 17.3%, compared with 8 of 171, 4.7%; P < .001). Among 104 women in the macrosomic group who labored after first vaginal delivery, 99% (103 of 104) delivered vaginally again compared with 44% (11 of 25) who labored after primiparous cesarean delivery (P < .001), which compares with 97% (146 of 150) and 77% (10 of 13), respectively, in the control group.


CONCLUSIONS
Despite a one-third recurrence of macrosomia, first vaginal delivery of a macrosomic infant was associated with a high incidence of second vaginal delivery. Conversely, primiparous macrosomic cesarean delivery conveyed a high risk (56%) for repeat intrapartum cesarean whether macrosomia recurred or not.


METHODS
II-2.
Departments of Obstetrics and Gynecology, National Maternity Hospital and University College Dublin, Ireland.
Rhona
R
Mahony
Colin
C
Walsh
Michael E
ME
Foley
Leslie
L
Daly
Colm
C
O'Herlihy
D000328:Adult; D001724:Birth Weight; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D036861:Delivery, Obstetric / Q000379:methods*; D016640:Diabetes, Gestational / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000175:diagnosis* / Q000453:epidemiology; D020567:Fetal Weight; D005500:Follow-Up Studies; D005865:Gestational Age; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D008423:Maternal Age; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000379:methods; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
D001786:Blood Glucose