Suspected fetal macrosomia and the risk of shoulder dystocia as an indication for cesarean section

S. Vladareanu, C. Andrei, D. Navolan, D. Badiu, T. Hangan, R. Vladareanu

Abstract: Macrosomia is associated with increased risk for perinatal complications including prolonged labor, shoulder dystocia, perinatal mortality and maternal morbidity including cesarean delivery, severe postpartum hemorrhage, and vaginal lacerations. Among maternal risk factors for fetal macrosomia are high body-mass index, diabetes mellitus, postterm pregnancy, previous macrosomic infant. Shoulder dystocia occurs in 0.2-3% of all births and represents an obstetric emergency. Although, in general, clinical estimates of birth weight perform favorably, ultrasound immediately prior to labour is more accurate at predicting the high birth-weight fetus. Ultrasound measurement of abdominal circumference and fetal biometry are the only practical methods used to detect fetal weight over 4000 g, but they are characterized by low sensitivity, low positive predictive value and high negative predictive value. Serial sonographic measurements can increase the positive predictive value. By combining three-dimensional volumetric measurements with two-dimensional measurements, should increase the ability to predict macrosomia. Nowadays, clinicians needs to examine all the information available to take a decision on whether the risk of macrosomia and shoulder dystocia is high, and if so then an elective caesarean section is indicated. Predicting fetal macrosomia does not imply that elective caesarean section is the method of choice, but it should be made clear to the couple that elective caesarean section is the low-risk option. Important to note is that each woman should be informed of the particular risks associated with a macrosomic fetus and shoulder dystocia. The mother should be supported in the decision, because it is a situation in which maternal autonomy is paramount.
DOI:10.18643/gieu.2015.39

Keywords: macrosomia, shoulder dystocia, cesarean section.