title: Increased composite maternal and neonatal morbidity associated with ultrasonographically suspected fetal macrosomia.
abstract: OBJECTIVE
  To determine the composite risk of maternal and neonatal morbidity in pregnancies with suspected fetal macrosomia.
  
  
  METHODS
  In a retrospective study of laboring women delivering singleton, term neonates, we defined 3 groups of patients by estimated fetal weight (EFW) in grams, using ultrasound: (1) <4000, (2) 4000-4499, and (3) 4500+, and tested them for association with a composite outcome using multivariable logistic regression models. The measure of composite morbidity included: shoulder dystocia, third/fourth degree perineal laceration, postpartum hemorrhage, maternal length of stay (LOS) ≥ 5 days, neonatal birth trauma, meconium aspiration syndrome, perinatal infection, and neonatal LOS ≥ 5 days. Because of potential interactions between diabetes and birthweight, women with maternal diabetes were examined separately.
  
  
  RESULTS
  Of 8,843 deliveries, the proportion with composite morbidity by group was: (1): 26.2%, (2): 41.2%, and (3): 63.6% (p < 0.0001). The OR (95% CI) for groups (2) and (3) were: 1.9 (1.2-2.9) and 2.1 (0.6-7.2), for diabetics (9.7% of the final study population), and 2.3 (1.9-2.7) and 3.9 (2.2-6.9), for non-diabetics.
  
  
  CONCLUSIONS
  Suspected fetal macrosomia appeared associated with increased risk for a composite measure of childbirth morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: King
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Korst
authors.forename: David A
authors.initials: DA
authors.lastname: Miller
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Ouzounian
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications* / Q000000981:diagnostic imaging; D020567:Fetal Weight; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000209:etiology*; D016017:Odds Ratio; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D055815:Young Adult