Department of Gynecology and Obstetrics, Mother and Children's Hospital, Limoges Regional University Hospital, 8 avenue Dominique Larrey, 87000, Limoges, France.
Laboratory of Mathematics and Its Applications, UMR CNRS 5142, Collège STTE-Campus de Montaury, 1 allée du parc de Montaury, 64600, Anglet, France.
Arch Gynecol Obstet. 2022 Oct;306(4):959-967. doi: 10.1007/s00404-022-06685-z. Epub 2022 Jul 19.
The management of fetal macrosomia remains controversial. A protocol for induction of labor in the case of a suspected macrosomic fetus has been in place in our maternity hospital since 2016. We studied the impact of this protocol by analyzing the mode of delivery. We then studied its safety in terms of maternal and fetal morbidity and mortality and the risk factors of macrosomia.
Retrospective, comparative, single-center study including 256 patients between 2016 and 2020 in a type 3 maternity hospital in France. We compared 114 patients induced at 39 weeks of gestation (fetal weight ≥ 95th p; group 1) with 142 patients who after 37 weeks of gestation delivered a macrosomic newborn (≥ 95th p according to Audipog; group 2) not diagnosed antenatally.
The rate of vaginal delivery in the group 1 was 78.9% vs 83.8% in group 2 (p = 0.318). The rate of neonatal acidosis in group 1 was statistically lower than in group 2 (5.2% vs 16.9%; p = 0.004). The other maternal and neonatal outcomes were not significantly different in the two groups. A previous macrosomic newborn appeared to be a risk factor for macrosomia (p = 0.02).
The establishment of a protocol for the induction of labor in the case of macrosomia in our maternity hospital did not increase the rate of vaginal delivery, but has a neonatal benefit, by significantly reducing neonatal acidosis.
巨大儿的处理仍然存在争议。自 2016 年以来，我们的妇产科医院就制定了疑似巨大儿胎儿引产的方案。我们通过分析分娩方式来研究该方案的影响。然后，我们研究了其在母婴发病率和死亡率方面的安全性，以及巨大儿的危险因素。
这是一项在法国三级妇产医院进行的回顾性、对比、单中心研究，纳入了 2016 年至 2020 年期间的 256 名患者。我们比较了 114 名在 39 孕周（胎儿体重≥第 95 百分位数；第 1 组）引产的患者与 142 名在 37 孕周后分娩巨大儿新生儿（根据 Audipog 诊断为≥第 95 百分位数；第 2 组）的患者。
第 1 组阴道分娩率为 78.9%，第 2 组为 83.8%（p=0.318）。第 1 组新生儿酸中毒发生率明显低于第 2 组（5.2%比 16.9%；p=0.004）。两组间其他母婴结局无显著差异。先前有巨大儿新生儿的病史似乎是发生巨大儿的危险因素（p=0.02）。
我们的妇产科医院制定了巨大儿引产方案，但并没有增加阴道分娩率，反而具有新生儿获益，因为它显著降低了新生儿酸中毒的发生率。
