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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 August;164(4):281-6
Is it possible to prevent fetal megalosomy?
Comparetto C. 1, Bertini G. 2, Rubaltelli F. F. 2, Borruto F. 3
1 U.O. Ostetricia e Ginecologia, Ospedale Misericordia e Dolce, Azienda U.S.L. n. 4 di Prato, Prato;
2 Dipartimento di Pediatria, Divisione di Neonatologia, Università degli Studi di Firenze, Firenze;
3 Dipartimento Materno-Infantile, Divisione di Ostetricia e Ginecologia, Università degli Studi di Verona, Verona
Aim. “Fetal macrosomia” means a birth weight of 4000 g or more, even if in literature there isn’t a clear definition of this condition. Actually, the correct term should be “large for gestational age fetus”, which includes all fetuses with birth weight more than 90th percentile. We report our experience and a review of the literature.
Methods. We studied the incidence and the possible complications of fetal macrosomia by a prospective evaluation of obstetric occurrences and births during the 4-year period 2000-2003. There have been therefore evaluated the number of macrosomic babies on the total of the newborns, the modalities of delivery, the eventual presence of fetal suffering, of congenital anomalies, of sequelae (and the type of them), the Apgar score, and the number of mothers affected by diabetes mellitus.
Results. Fetal macrosomia was related to an increase of maternal complications due to a stronger incidence of feto-pelvic disproportions, which means a longer duration of delivery, a stronger incidence of operative delivery, and of post-partum haemorrhages and vagino-perineal lacerations. On the other hand, there was an increase of perinatal morbidity, with a stronger incidence of fetal suffering and of the feared shoulder dystocia.
Conclusions. With the increasing spread of ultrasonography and the subsequent possibility to foretell in a repeatable way fetal weight, the problem of large size fetuses seems to find a solution, and to this solution also bring the rise of juridical proceedings in medicine and the heavy sequelae of shoulder dystocia.