Obstetric and neonatal outcomes of spontaneous labor with a large fetus depending on the gestational age
Tysyachnyi O.V., Prikhodko A.M., Baev O.R.
Background: Fetuses that are large for gestational age pose a risk of macrosomia, particularly when excessive growth occurs at full-term gestational age. However, not all large-for-gestational-age fetuses are born with macrosomia, which can result from either earlier delivery or a decrease in growth rate over time. Existing studies on the outcomes of labor induction for fetal macrosomia typically focus on fetal body weight at the time of induction, with few considering gestational age. Investigating the outcomes of spontaneous labor in large-for-gestational-age fetuses can help to identify the most favorable gestational age for delivery and reduce the incidence of such cases.
Objective: To study obstetric and neonatal outcomes of spontaneous labor with a large fetus depending on gestational age.
Materials and methods: This retrospective cohort study included 571 healthy primiparous women who were divided into two groups based on ultrasound findings. The control group comprised pregnancies with fetal sizes ranging from the 10th to the 80th percentile (n=345), while the study group included pregnancies with large-for-gestational-age fetuses above the 90th percentile (n=226). Each group was further divided into four subgroups: subgroup 1 – gestational age 37 weeks, subgroup 2 – 38 weeks, subgroup 3 – 39 weeks, and subgroup 4 – 40 weeks.
Results: The overall rates of operative deliveries and cesarean sections were significantly higher in the study group – 23% versus 11.6% for operative deliveries (p=0.0004) and 21.2% versus 8.7% for cesarean sections (p<0.0001). Among women with large fetuses at 36–37 weeks of pregnancy, every third observation at 38–39 weeks resulted in the birth of a child with macrosomia, whereas this occurred every in second observation at 40 weeks. The lowest cesarean section rates and occurrence of large fetuses were noted at 38–39 weeks.
Conclusion: Pregnant women with an estimated fetal weight at the 90th percentile or higher, determined by ultrasound at 36–37 weeks, are at an increased risk of higher cesarean section rates and the birth of large fetuses. The optimal delivery window for these cases was between the end of the 37th week and the beginning of the 39th week, during which the lowest cesarean section rates were observed.
Authors’ contributions: Baev O.R. – conception and design of the study; Tysyachnyi O.V. – material collection and processing, drafting of the manuscript, statistical analysis; Prikhodko A.M. – editing of the manuscript.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: There was no funding for this study.
Ethical Approval: The study was reviewed and approved by the Research Ethics Committee of the V.I. Kulakov NMRC for OG&P.
Patient Consent for Publication: All patients provided informed consent for the publication of their data.
Authors' Data Sharing Statement: The data supporting the findings of this study are available upon request from the corresponding author after approval from the principal investigator.
For citation: Tysyachnyi O.V., Prikhodko A.M., Baev O.R. Obstetric and neonatal outcomes of
spontaneous labor with a large fetus depending on the gestational age.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2025; (4): 44-50 (in Russian)
https://dx.doi.org/10.18565/aig.2025.36
Keywords
induction of labor
large-for-gestational-age fetus
fetal macrosomia
large fetus
References
- Bair C.A., Cate J., Chu A., Kuller J.A., Dotters-Katz S.K. Nondiabetic fetal macrosomia: causes, outcomes, and clinical management. Obstet. Gynecol. Surv. 2024; 79(11): 653-64. https://dx.doi/org/10.1097/OGX.0000000000001326.
- Chandrasekaran N. Induction of labor for a suspected large-for-gestational-age/macrosomic fetus. Best Pract. Res. Clin. Obstet. Gynaecol. 2021; 77: 110-8. https://dx.doi/org/10.1016/j.bpobgyn.2021.09.005.
- Rezaiee M., Aghaei M., Mohammadbeigi A., Farhadifar F., Zadeh Ns., Mohammadsalehi N. Fetal macrosomia: risk factors, maternal, and perinatal outcome. Ann. Med. Health Sci. Res. 2013; 3(4): 546. https://dx.doi/org/10.4103/2141-9248.122098.
- Одинокова В.А., Шмаков Р.Г. Исходы родов у первородящих с фетальной макросомией при активной и выжидательной тактике. Акушерство и гинекология. 2022; 1: 72-9. [Odinokova V.A., Shmakov R.G. Birth outcomes in primiparous women diagnosed with fetal macrosomia and managed with active surveillance and watch-and-wait approach. Obstetrics and Gynecology. 2022; (1): 72-9 (in Russian)]. https://dx.doi.org/10.18565/aig.2022.1.72-79.
- Giouleka S., Tsakiridis I., Ralli E., Mamopoulos A., Kalogiannidis I., Athanasiadis A. et al. Diagnosis and management of macrosomia and shoulder dystocia: A comprehensive review of major guidelines. Obstet. Gynecol. Surv. 2024; 79(4): 233-41. https://dx.doi/org/10.1097/OGX.0000000000001253.
- Boulvain M., Irion O., Dowswell T., Thornton J.G. Induction of labour at or near term for suspected fetal macrosomia. Cochrane Database Syst. Rev. 2016; 2016(5): CD000938. https://dx.doi/org/10.1002/14651858.CD000938.pub2.
- Badr D.A., Carlin A., Kadji C., Kang X., Cannie M.M., Jani J.C. Timing of induction of labor in suspected macrosomia: retrospective cohort study, systematic review and meta‐analysis. Ultrasound Obstet. Gynecol. 2024; 64(4): 443-52. https://dx.doi/org/10.1002/uog.27643.
- Hong J., Crawford K., Odibo A.O., Kumar S. Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term. Am. J. Obstet. Gynecol. 2023; 229(4) :451.e1-451.e15. https://dx.doi/org/10.1016/j.ajog.2023.04.044.
- Boulvain M., Senat M.V., Perrotin F., Winer N., Beucher G., Subtil D. et al.; Groupe de Recherche en Obstétrique et Gynécologie (GROG). Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial. Lancet. 2015; 385(9987): 2600-5. https://dx.doi/org/10.1016/S0140-6736(14)61904-8.
- Капустин Р.В., Коптеева Е.В., Алексеенкова Е.Н., Цыбук Е.М., Аржанова О.Н., Коган И.Ю. Анализ факторов риска дистоции плечиков плода в родах у женщин с сахарным диабетом. Акушерство и гинекология. 2022; 9: 54-63. [Kapustin R.V., Kopteeva E.V., Alekseenkova E.N., Tsybuk E.M., Arzhanova O.N., Kogan I.Yu. Risk factors for shoulder dystocia during labor in women with diabetes mellitus. Obstetrics and Gynegology. 2022; (9): 54-63. (in Russian)]. https://dx.doi/org/10.18565/aig.2022.9.54-63.
- Boulvain M., Thornton J.G. Induction of labour at or near term for suspected fetal macrosomia. Cochrane Database Syst. Rev. 2023; 3(3): CD000938. https://dx.doi/org/10.1002/14651858.CD000938.pub3.
Received 19.02.2025
Accepted 24.03.2025
About the Authors
Oleg V. Tysyachnyi, PhD, Researcher at the 1st Maternity Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4, o_tysyachny@oparina4.ru, https://orcid.org/0000-0001-9282-9817
Oleg R. Baev, Dr. Med. Sci., Professor, Head of the 1st Maternity Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4; Professor at the Department of Obstetrics, Gynecology, Perinatology, and Reproductology,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, +7(495)438-11-88, o_baev@oparina4.ru, https://orcid.org/0000-0001-8572-1971
Andrey M. Prikhodko, Dr. Med. Sci., doctor at the 1st Maternity Department, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparin str., 4, +7(495)438-11-88, a_prikhodko@oparina4.ru, https://orcid.org/0000-0002-6615-2360
Similar Articles
