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Prevention, Management, and Outcomes of Macrosomia: A Systematic Review of Literature and Meta-analysis

Rossi, A. Cristina MD*; Mullin, Patrick MD; Prefumo, Federico MD, PhD

Obstetrical & Gynecological Survey: October 2013 - Volume 68 - Issue 10 - p 702–709
doi: 10.1097/01.ogx.0000435370.74455.a8
CME Articles: Prevention, Management, Outcomes of Macrosomia

Macrosomia represents an obstetric challenge, and when suspected, there is no general consensus as to whether expectant management, induction of labor, or elective cesarean delivery are the best option. This review article was aimed to discuss literature published in the last decade about the identification, management, and outcomes of macrosomia. The identification of macrosomia remains uncertain, mainly because of the high heterogeneity across studies because of different definitions of macrosomia, gestational age at time of assessment, and fetal weight formulas. With regard to management and outcomes of macrosomia, 12,212 macrosomic neonates can be pooled from 17 articles. Compared with neonates with normal birth weight, the odds ratio of emergency cesarean delivery increases from 1.92 (1.53–2.42) to 2.24 (1.42–3.56) and 5.20 (3.47–7.79) for macrosomia 4000 g or greater, 4500 g or greater, and 5000 g or greater, respectively. The odds ratios of shoulder dystocia are 7.18 (2.06–25.00), 7.33 (5.13–10.48), and 16.16 (7.62–34.26) for macrosomia 4000 g or greater, 4500 g or greater, and 5000 g or greater, respectively. Three birth traumas were reported after cesarean delivery. Perinatal mortality is similar between macrosomic and neonates with normal birth weight at each cutoff of macrosomia. Nonetheless, limitations of current literature, which are also discussed in this review, do not allow to drive definitive conclusion about the management of macrosomia.

Target Audience: Obstetricians and gynecologists, family physicians

Learning Objectives: After completing this CME activity, physicians should be better able to determine the optimal mode of delivery for pregnant women whose fetuses may be macrosomic, identify the potential risks of adverse neonatal outcomes in macrosomic fetuses, and identify the limitations in the obstetric literature on macrosomia.

*Doctor, Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy; †Doctor, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, CA; and ‡Doctor, Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: A. Cristina Rossi, MD, Via Celentano, 42, 70121 Bari, Italy. E-mail: acristinarossi@yahoo.it.

© 2013 by Lippincott Williams & Wilkins.