title: Maternal and fetal outcomes of large fetus delivery: a comparative study.
abstract: OBJECTIVE
  To review the deliveries of macrosomic babies, weighing over than 4000g and their obstetrical and neonatal outcomes.
  
  
  METHODS
  Retrospective study involving a total of 209 deliveries at term of macrosomic babies between Marsh 2006 and February 2007 in the Maternity Hospital of Mahmoud ELMATRI, Tunis. The study concerned risk factors, mode of delivery and the incidence of maternal and perinatal complications.We compared data in the study group to a control group of normal weight infants delivered at the same period.
  
  
  RESULTS
  Macrosomia occurred in 9.2% of all deliveries. The main risk factors of macrosomia were maternal age over 30 years (p=0,017), multiparty (p<0.001), diabetes mellitus (p=0.012) and prolonged term of delivery (p=0.02). These risk factors were statistically significant compared to control group. Caesarian delivery was achieved in 24.4% in macrosomy group and in 13.7% in control group (p=0,003) the major part occurred during labor. Among vaginal deliveries in macrosomia group, shoulder dystocia was noted in 1,9%, fetal respiratory failure and admission in intensive care unit was noted in 4,8% of the cases and hypoglycemia complicated 15,8% of deliveries. Maternal complications were dominated by post partum hemorrhage documented in 1.2% of the cases and perineal tears noted in 8,2% of vaginal deliveries.
  
  
  CONCLUSIONS
  Vaginal delivery is the most frequent mode of delivery for a fetus weighing in excess of 4 kg and vaginal delivery should be attempted in the absence of contraindications and there is no need for elective systematic caesarian. However, shoulder dystocia remains the main complication of vaginal delivery for macrosomic fetuses and requires experienced obstetricians to manage these deliveries.
authors.affiliation: Obstetrics and Gynaecology Department, Tunis El Manar University, Tunisia.
authors.forename: Chiraz
authors.initials: C
authors.lastname: El Fekih
authors.forename: Mechaal
authors.initials: M
authors.lastname: Mourali
authors.forename: Nadia
authors.initials: N
authors.lastname: Ouerdiane
authors.forename: Seddik
authors.initials: S
authors.lastname: Oueslati
authors.forename: Amine
authors.initials: A
authors.lastname: Hadj Hassine
authors.forename: Mounira
authors.initials: M
authors.lastname: Chaabene
authors.forename: Nabil
authors.initials: N
authors.lastname: Ben Zineb
mesh_terms: D036861:Delivery, Obstetric; D005260:Female; D005320:Fetal Macrosomia; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies