Maternal Complications Associated with Delivery of Babies Weighing 4500 Grams and Above
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Abstract
Background: Fetal macrosomia is delivery of a baby with birth weight of 4000g and above. It is a high risk pregnancy, and it is associated with maternal and fetal complications, especially during delivery.
Objectives: To determine whether delivery of macrosomic babies weighing ≥ 4.5kg results in more maternal complications than babies weighing < 4.5kg. It would also determine the socio-demographic characteristics of the women.
Method and materials: This was an analytic retrospective cross-sectional study of 200 women who delivered macrosomic babies during the study period; 46 babies weighed ≥ 4.5kg, while 154 (macrosomic) babies who weighed < 4.5kg were used as control. Data collected included bio-data, booking status, gestational age at delivery, and birth weight (≥4.5kg or < 4.5kg). Data on maternal complications were: episiotomy incision during vaginal delivery, perineal tear (1st, 2nd , and 3rd degree), cervical laceration, estimated blood loss during delivery, and primary postpartum hemorrhage (PPH). Other data retrieved were the mode of delivery, such as: spontaneous vaginal delivery (SVD), caesarean section (CS), and instrumental vaginal delivery (vacuum and obstetrics forceps).
Results: The prevalence of fetal macrosomia was 7.0%, the mean birth weight was 4.30 ± 0.27 kg, the mean maternal age was 31.64 ± 4.0 years, and the mean gestational age (GA) at delivery was 39.7 ± 0.78 weeks Demographic factors that were significantly associated with birth weight ≥ 4.5kg are: Ijaw tribe (p = 0.03), tertiary level of education (P = 0.005), unbooked status (p = 0.02), and postdate (p = 0.0001). Regarding genital tract trauma, the chances of receiving episiotomy incision was 8 times higher among the women who delivered babies weighing ≥ 4.5 grams, odds ratio = 8.31[1.09, 63.19], p = 0.01. Also, the chances of having 2nd degree perineal tear was 5 time higher, odds ratio = 5.17[1.00, 20.60], p = 0.0. The rate of vacuum delivery was increased by 6 folds among women who delivered babies weighing ≥ 4.5kg, odds ratio = 6.14[0.80, 47.23], p = 0.03, and the CS rate by 2 folds, odds ratio = 2.79[1.37, 5.68], p = 0.03. The mean blood loss was significantly higher among women delivered by caesarean section t = 14.9 [396.9, 517.2], p = 0.0001
Conclusion: The maternal complications of fetal macrosomia escalate with increase in birth weight (≥ 4.5kg). Prominent among these are: genital tract trauma, use of instrumental vaginal delivery, and increase in caesarean section rate.
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