Counseling for fetal macrosomia: an estimated fetal weight of 4,000 g is excessively low.
OBJECTIVE
Because of the known complications of fetal macrosomia, our hospital's policy has been to discuss the risks of shoulder dystocia and cesarean section (CS) in mothers with a sonographic estimated fetal weight (SEFW) ≥ 4,000 g at term. The present study was performed to determine the effect of this policy on CS rates and pregnancy outcome.


METHODS
We examined the pregnancy outcomes of the macrosomic (≥ 4,000 g) neonates in two cohorts of nondiabetic low risk women at term without preexisting indications for cesarean: (1) SEFW ≥ 4,000 g (correctly suspected macrosomia) and (2) SEFW < 4,000 g (unsuspected macrosomia).


RESULTS
There were 238 neonates in the correctly suspected group and 205 neonates in the unsuspected macrosomia group, respectively. Vaginal delivery was accomplished in 52.1% of the suspected group and 90.7% of the unsuspected group, respectively, p < 0.001. There was no difference in the rates of shoulder dystocia. The odds ratio for CS was 9.0 (95% confidence interval, 5.3-15.4) when macrosomia was correctly suspected.


CONCLUSIONS
The policy of discussing the risk of macrosomia with SEFW ≥ 4,000 g to women is not justified. A higher SEFW to trigger counseling for shoulder dystocia and CS, more consistent with American College of Obstetrics and Gynecology (ACOG) guidelines, should be considered.
Departments of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University Medical School, Zefat, Israel.
David
D
Peleg
Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, Virginia.
Steven
S
Warsof
Departments of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University Medical School, Zefat, Israel.
Maya Frank
MF
Wolf
Departments of Obstetrics and Gynecology, Baruch Padeh Medical Center, Poriya, Israel.
Yuri
Y
Perlitz
Departments of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University Medical School, Zefat, Israel.
Inbar Ben
IB
Shachar
D000328:Adult; D002585:Cesarean Section; D015331:Cohort Studies; D003376:Counseling / Q000379:methods*; D036861:Delivery, Obstetric; D004420:Dystocia; D005260:Female; D005320:Fetal Macrosomia / Q000000981:diagnostic imaging*; D020567:Fetal Weight; D006801:Humans; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D055815:Young Adult