title: Maternal and neonatal outcomes of macrosomic pregnancies.
abstract: BACKGROUND
  To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies.
  
  
  METHODS
  A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000-4250 g, 4250-4500 g and ≥4500 g).
  
  
  RESULTS
  The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000-4250 g, 4250-4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000-4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups.
  
  
  CONCLUSIONS
  Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500 g group.
authors.affiliation: Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel HaShomer, Israel. alinabrenner@yahoo.com
authors.forename: Alina
authors.initials: A
authors.lastname: Weissmann-Brenner
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Simchen
authors.forename: Eran
authors.initials: E
authors.lastname: Zilberberg
authors.forename: Anat
authors.initials: A
authors.lastname: Kalter
authors.forename: Boaz
authors.initials: B
authors.lastname: Weisz
authors.forename: Reuven
authors.initials: R
authors.lastname: Achiron
authors.forename: Mordechai
authors.initials: M
authors.lastname: Dulitzky
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D004420:Dystocia / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005320:Fetal Macrosomia / Q000150:complications / Q000453:epidemiology*; D020567:Fetal Weight / Q000502:physiology; D049674:History, 21st Century; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology*; D007557:Israel / Q000453:epidemiology; D016015:Logistic Models; D008428:Maternal Mortality / Q000266:history*; D016017:Odds Ratio; D006473:Postpartum Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies