Date: 2008-03-18 20:32 Subject: Background on "Deliver big babies early!" eejitry Security: Public

I've just realised that some of you might still be catching up on just how brain-burningly ignorant "But delivering potentially big babies early is good for them!" is. So, a few snippets of background from Pubmed.

Terminology:

- macrosomia = big baby (generally over 4 kg, a category that 10-15% of completely normal healthy babies fall into)
- Apgar = scoring of fetal characteristics associated with well-being (heart rate, tone, colour, breathing)
- shoulder dystocia = stuck shoulders
- post dates = gestation >42 weeks.

"Labor induction with a prenatal diagnosis of fetal macrosomia.": induction of labour for suspect fetal macrosomia led to an increased risk of regional anaesthesia (eg epidural) and C section. No difference in Apgars or shoulder dystocia rates.

Large fetus--a retrospective study: Induction of labour for fetal macrosomia did not increase the Apgar score or diminish the frequency of shoulder dystocia, but it did increase the frequency of operative deliveries and transfer to the neonatal unit.


"Expectant management versus labor induction for suspected fetal macrosomia: a systematic review.": Labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes.

"To induce or not to induce labor: a macrosomic dilemma.": Induction of labour with macrosomic fetus on board was associated with an increase in C section risk.

"Treatment of suspected fetal macrosomia: a cost-effectiveness analysis.": Cost effectiveness analysis shows that expectant management of suspected macrosomia is the most cost effective.

"Shoulder dystocia: the unpreventable obstetric emergency with empiric management guidelines." (a review): "Induction of labor for suspected fetal macrosomia has not been shown to alter the incidence of shoulder dystocia among nondiabetic patients."

"The macrosomic fetus: a challenge in current obstetrics.": "Prediction of fetal macrosomia remains an inaccurate task even with modern ultrasound equipment. There is little evidence that routine elective delivery (induction or caesarean section) for the mere reason of suspected macrosomia should be employed in a general population."

"Suspected macrosomia? Better not tell.": "Our ability to predict macrosomia is poor. Our management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome."

"Expectant management of post-term patients: observations and outcome.": Postdates births were actually associated with a decrease in fetal distress, instrumental delivery, and low Apgar scores, compared to term births. There was no difference in induction, meconium presence, shoulder dystocia, high birthweight, or C section rate.