About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Procedure for reviewingReviewers 2023-2024
Logout
Obstetrics and Gynegology2022№7
Modern aspects of obstetric tactics...

Modern aspects of obstetric tactics for fetal macrosomia

DOI
https://dx.doi.org/10.18565/aig.2022.7.21-27

Odinokova V.A., Shmakov R.G.

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, Moscow, Russia
Fetal macrosomia occurs in about 10% of all pregnancies, tends to increase constantly, and is often associated with an increased risk of maternal and perinatal complications. Despite the relatively high incidence of fetal macrosomia, many aspects of management and delivery in this category of pregnant women are controversial. Some authors adhere to expectant tactics, while others prefer active strategies (early pre-induction/induction of labor or planned cesarean section). Questions remain about the impact of early pre-induction/induction of labor on the risk of cesarean section and perinatal morbidity in patients with suspected fetal macrosomia. The lack of generally accepted obstetric tactics has the reason for determining the purpose of our study, namely, to assess the data available in Russian and foreign literature on the methods and terms of delivery of pregnant women with fetal macrosomia, depending on their existing carbohydrate metabolism disorders. The analysis of the data available in the literature and the results of previous studies have shown that there is a need to elaborate Russian clinical guidelines for the management of pregnant women with fetal macrosomia, the introduction of which will be able to facilitate the decision-making process when choosing obstetric tactics, as well as to reduce the rates of cesarean section and maternal and perinatal complications.
Conclusion: Future investigations should aim at clarifying the optimal timing of pre-induction/induction of labor and the method of delivery for women without diabetes and fetal macrosomia, taking into account their parity and history. Increasing the accuracy of diagnosing the estimated fetal weight remains one of the priority tasks for an obstetrician/gynecologist, the solution of which will lead to a decrease in the rate of planned caesarean section and to inappropriate labor induction.

Keywords

fetal macrosomia
large fetus
gestational diabetes mellitus
planned labor induction
planned caesarean section
expectant tactics
Full text (in Russian)

References

  1. Ye J., Torloni M.R., Ota E., Jayaratne K., Pileggi-Castro C., Ortiz-Panozo E. et al. Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America. BMC Pregnancy Childbirth. 2015; 15: 324. https://dx.doi.org/10.1186/s12884-015-0765-z.
  2. Weissmannbrenner A., Simchen M.J., Zilberberg E., Kalter A., Weisz B.,Achiron R., Dulitzky M. Maternal and neonatal outcomes of large for gestational age pregnancies. Acta Obstet. Gynecol. Scand. 2012; 91(7): 844-9.https://dx.doi.org/10.1111/j.1600-0412.2012.01412.x.
  3. Мирошник Е.В., Рюмина И.И., Зубков В.В. Влияние сахарного диабета матери на здоровье новорожденного. Акушерство и гинекология. 2016; 9: 45-9. [Miroshnik E.V., Ryumina I.I., Zubkov V.V. Impact of maternal diabetes mellitus on neonatal health. Obstetrics and Gynecology. 2016; 9: 45-9.(in Russian)]. https://dx.doi.org/10.18565/aig.2016.9.45-9.
  4. Сухих Г.Т., Краснопольский В.И., Рунихина Н.К., Ткачева О.Н., Ходжаева З.С., Петрухин В.А., Шестакова М.В., Бурумкулова Ф.Ф., Есаян Р.М., Колегаева О.И., Шарашкина Н.В., Кирсанова Т.В., Кошель Л.В. Переход на новый уровень ведения гипертензивных и метаболических осложнений при беременности: современные критерии диагностики гестационного сахарного диабета. Акушерство и гинекология. 2013; 3: 4-9. [Sukhikh G.T., Krasnopolsky V.I., Runikhina N.K., Tkacheva O.N., Khodzhaeva Z.S., Petrukhin V.A., Shestakova M.V., Burumkulova F.F.,Esayan R.M., Kolegaeva O.I., Sharashkina N.V., Kirsanova T.V.,Koshel L.V. Transition to a new level of management of hypertensive and metabolic complications in pregnancy: Current diagnostic criteria for gestational diabetes mellitus. Obstetrics and Gynecology. 2013; 3: 4-9. (in Russian)].
  5. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet. Gynecol. 2020; 135(1): e18-e35. https://dx.doi.org/10.1097/AOG.0000000000003606.
  6. Boulet S.L., Alexander G.R., Salihu H.M., Pass M. Macrosomic births in the united states: determinants, outcomes, and proposed grades of risk. Am. J. Obstet. Gynecol. 2003; 188(5): 1372-8. https://dx.doi.org/10.1067/mob.2003.302.
  7. Acker D.B., Sachs B.P., Friedman E.A. Risk factors for shoulder dystocia. Obstet. Gynecol. 1985; 66(6): 762-8.
  8. Nesbitt T.S., Gilbert W.M., Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am. J. Obstet. Gynecol. 1998; 179(2): 476-80. https://dx.doi.org/10.1016/s0002-9378(98)70382-5.
  9. Spellacy W.N., Miller M.S., Winegar A., Peterson P.Q. Macrosomia – maternal characteristics and infant complications. Obstet. Gynecol. 1985; 66(2):158-61.
  10. Ecker J.L., Greenberg J.A., Norwitz E.R., Nadel A.S., Repke J.T. Birth weight as a predictor of brachial plexus injury. Obstet. Gynecol. 1997; 89(5, Pt 1): 643-7. https://dx.doi.org/10.1016/s0029-7844(97)00007-0.
  11. Gregory K.D., Henry O.A., Ramicone E., Chan L.S., Platt L.D. Maternal and infant complications in high and normal weight infants by method of delivery. Obstet. Gynecol. 1998; 92(4, Pt 1): 507-13. https://dx.doi.org/10.1016/s0029-7844(98)00224-5.
  12. Committee on Practice B-O. ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet. Gynecol. 2018; 131(2): e49-e64. 10.1097/AOG.0000000000002501.
  13. Royal College of Obstetricians and Gynaecologists. Shoulder dystocia ( Green-Top Guideline No. 42). March 28, 2012.
  14. Клинические рекомендации «Роды одноплодные, родоразрешение путем кесарева сечения». М.; 2021. 106с. [Clinical guidelines "Single birth, delivery by caesarean section". Moscow; 2021. 106 p. (in Russian)].
  15. Шмаков Р.Г., Баев О.Р., Пекарев О.Г., Пырегов А.В., Приходько А.М., Павлович С.В. Кесарево сечение. Показания, хирургическая техника, методы обезболивания. Учебное пособие. М.: Системные решения; 2016. 65 с. [Shmakov R.G., Baev O.R., Pekarev O.G., Pyregov A.V., Prikhodko A.M., Pavlovich S.V. Caesarean section. Indications, surgical technique, methods of anesthesia. Textbook. M.: LLC IPF "System solutions"; 2016. 65 p.(in Russian)].
  16. Grobman W.A., Bailit J., Lai Y., Reddy U.M., Wapner R.J., Varner M.W. et al. Defining failed induction of labor. Am. J. Obstet. Gynecol. 2018; 218(1): 122.e1-122. e8. https://dx.doi.org/10.1016/j.ajog.2017.11.556.
  17. Practice Bulletin No 178: Shoulder dystocia. Obstet. Gynecol. 2017; 129(5): e123-e133. https://dx.doi.org/10.1097/AOG.0000000000002043.
  18. Bingham J., Chauhan S.P., Hayes E., Gherman R., Lewis D. Recurrent shoulder dystocia: a review. Obstet. Gynecol. Surv. 2010; 65(3): 183-8.https://dx.doi.org/10.1097/OGX.0b013e3181cb8fbc.
  19. Kleitman V., Feldman R., Walfisch A., Toledano R., Sheiner E. Recurrent shoulder dystocia: is it predictable? Arch. Gynecol. Obstet. 2016; 294(6): 1161-6.https://dx.doi.org/10.1007/s00404-016-4139-1.
  20. Sentilhes L., Sénat M.-V., Boulogne A.-I., Deneux-Tharaux C., Fuchs F., Legendre G. et al. Shoulder dystocia: guidelines for clinical practice--short text. J. Gynecol. Obstet. Biol. Reprod. (Paris). 2015; 44(10): 1303-10.https://dx.doi.org/10.1016/j.jgyn.2015.09.053.
  21. 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.
  22. Tita A.T., Landon M.B., Spong C.Y., Lai Y., Leveno K.J., Varner M.W. et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units Network. N. Engl. J. Med. 2009; 360(2): 111-20. https://dx.doi.org/10.1056/NEJMoa0803267.
  23. Reddy U.M., Bettegowda V.R., Dias T., Yamada-Kushnir T., Ko C.W., Willinger M. Term pregnancy: a period of heterogeneous risk for infant mortality. Obstet. Gynecol. 2011; 117(6): 1279-87. https://dx.doi.org/10.1097/AOG.0b013e3182179e28.
  24. Spong C.Y. Defining “term” pregnancy: recommendations from the Defining “Term” Pregnancy Workgroup. JAMA. 2013; 309(23): 2445-6.https://dx.doi.org/10.1001/jama.2013.6235.
  25. Souza J.P., Gu¨lmezoglu A.M., Carroli G., Lumbiganon P., Qureshi Z.; WHOMCS Research Group. The World Health Organization Multicountry Survey on Maternal and Newborn Health: study protocol. BMC Health Serv. Res. 2011; 11: 286. https://dx.doi.org/10.1186/1472-6963-11-286.
  26. Avoidance of nonmedically indicated early-term deliveries and associated neonatal morbidities. ACOG Committee Opinion No. 765. American College of Obstetricians and Gynecologists. Obstet. Gynecol. 2019; 133: e156-e163. https://dx.doi.org/10.1097/AOG.0000000000003076
  27. Reddy U.M., Ko C.W., Raju T.N., Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics. 2009; 124(1): 234-40. https://dx.doi.org/10.1542/peds.2008-3232.
  28. Dueker G., Chen J., Cowling C., Haskin B. Early developmental outcomes predicted by gestational age from 35 to 41 weeks. Early Hum. Dev. 2016; 103: 85-90. https://dx.doi.org/10.1016/j.earlhumdev.2016.07.006.
  29. Cheng Y.W., Sparks T.N., Laros R.K. Jr, Nicholson J.M., Caughey A.B. Impending macrosomia: will induction of labour modify the risk of caesarean delivery? BJOG. 2012; 119(4): 402-9. https://dx.doi.org/10.1111/j.1471-0528.2011.03248.x.
  30. Sanchez-Ramos L., Bernstein S., Kaunitz A.M. Expectant management versus labor induction for suspected fetal macrosomia: a systematic review. Obstet. Gynecol. 2002; 100(5, Pt 1): 997-1002.
  31. Boulvain M., Senat M.V., Perrotin F., Winer N., Beucher G., Subtil D. et al. 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.
  32. Magro-Malosso E.R., Saccone G., Chen M., Navathe R., Di Tommaso M., Berghella V. Induction of labour for suspected macrosomia at term in non-diabetic women: a systematic review and meta-analysis of randomized controlled trials. BJOG. 2017; 124(3): 414-21. https://dx.doi.org/10.1111/1471-0528.14435.
  33. Клинические рекомендации «Неудачная попытка стимуляции родов (подготовка шейки матки к родам и родовозбуждение)». М.; 2021. 61с. [Clinical guidelines "Unsuccessful attempt to stimulate labor (preparation of the cervix for childbirth and labor excitation). Moscow; 2021. 61c.(in Russian)].
  34. Moldéus K., Cheng Y.W., Wikström A.-K., Stephansson O. Induction of labor versus expectant management of large-for-gestational-age infants in nulliparous women. PLoS One. 2017; 12(7): e0180748. https://dx.doi.org/10.1371/journal.pone.0180748.
  35. 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.
  36. Malin G.L., Bugg G.J., Takwoingi Y., Thornton J.G., Jones N.W. Antenatal magnetic resonance imaging versus ultrasound for predicting neonatal macrosomia: a systematic review and meta-analysis. BJOG. 2016; 123(1): 77-88. https://dx.doi.org/10.1111/1471-0528.13517.
  37. Aviram A., Yogev Y., Ashwal E., Hiersch L., Danon D., Hadar E. et al. Different formulas, different thresholds and different performance-the prediction of macrosomia by ultrasound. J. Perinatol. 2017; 37(12): 1285-91.https://dx.doi.org/10.1038/jp.2017.134.
  38. Zafman K.B., Bergh E., Fox N.S. Accuracy of sonographic estimated fetal weight in suspected macrosomia: the likelihood of overestimating and underestimating the true birthweight. J. Matern. Fetal Neonatal Med. 2020; 33(6): 967-72. https://dx.doi.org/10.1080/14767058.2018.1511697.
  39. NICE clinical guideline 70 – Evidence Update 44 – Induction of labour. July 2013.
  40. World Health Organization. WHO recommendations: induction of labour at or beyond term. Geneva: WHO; 2018.
  41. Leduc D., Biringer A., Lee L., Dy J.; Clinical Practice Obstetrics Committee; Special Contributors. Induction of labour. J. Obstet. Gynaecol. Can. 2013; 35(9): 840-57. https://dx.doi.org/10.1016/s1701-2163(15)30842-2.
  42. Berger H., Gagnon R., Sermer M., Basso M., Bos H., Brown R.N., Bujold E., Cooper S.L., Gagnon R,. Gouin K., McLeod N.L., Menticoglou S.M., Mundle W.R., Roggensack A., Sanderson F.L., Walsh J.D. Diabetes in Pregnancy. J. Obstet. Gynaecol. Can. 2016; 38(7): 667-79. https://doi.org/10.1016/j.jogc.2016.04.002.
  43. Rayburn W.F., Zhang J. Rising rates of labor induction: present concerns and future strategies. Obstet. Gynecol. 2002; 100(1): 164-7.https://dx.doi.org/10.1016/s00297844(02)02047-1.
  44. Combs C.A., Singh N.B., Khoury J.C. Elective induction versus spontaneous labor after sonographic diagnosis of fetal macrosomia. Obstet. Gynecol. 1993; 81(4): 492-6.
  45. Spong C.Y., Mercer B.M., D’alton M., Kilpatrick S., Blackwell S., Saade G. Timing of indicated late-preterm and early-term birth. Obstet. Gynecol. 2011; 118(2, Pt1): 323-33. https://dx.doi.org/10.1097/AOG.0b013e3182255999.
  46. ACOG. Committee Opinion No. 560. Medically indicated late-preterm and early-term deliveries. Obstet. Gynecol. 2013; 121(4): 908-10.https://dx.doi.org/10.1097/01.AOG.0000428648.75548.00.
  47. Alberico S., Erenbourg A., Hod M., Yogev Y., Hadar E., Neri F. et al.; GINEXMAL Group. Immediate delivery or expectant management in gestational diabetes at term: the GINEXMAL randomised controlled trial. BJOG. 2017; 124(4):669-77. https://dx.doi.org/10.1111/1471-0528.14389.
  48. ACOG Practice Bulletin No. 190: Gestational diabetes mellitus. Obstet. Gynecol. 2018; 131(2): e49-e64. https://dx.doi.org/10.1097/AOG.0000000000002501.
  49. National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period. NICE guideline. February 25, 2015. Available at: nice.org.uk/guidance/ng3 Accessed August 26, 2019.
  50. WHO recommendations for induction of labour: Evidence base. 2014.
  51. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 201: Pregestational diabetes mellitus. Obstet. Gynecol. 2018; 132(6): e228-e248. https://dx.doi.org/10.1097/AOG.0000000000002960.

Received 21.04.2022

Accepted 24.05.2022

About the Authors

Victoria A. Odinokova, postgraduate student, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health
of Russia, v_odinokova@oparina4ru, 117997, Russian Federation, Moscow, Oparin str., 4.
Roman G. Shmakov, Dr. Med. Sci., Professor of the RAS, Head of the Institute of Obstetrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, r_shmakov@oparina4.ru, https://orcid.org/0000-0002-2206-1002, 117997, Russian Federation, Moscow, Oparin str., 4.

Authors' contributions: Odinokova V.A. – concept and design of the investigation, review of publications on the topic of the article, analysis of the findings, writing the text of the manuscript; Shmakov R.G. – editing.
Conflicts of interest: The authors declare that there are no possible conflicts of interest.
Funding: The investigation has been conducted with no additional funding.
For citation: Odinokova V.A., Shmakov R.G.
Modern aspects of obstetric tactics for fetal macrosomia.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2022; 7: 21-27 (in Russian)
https://dx.doi.org/10.18565/aig.2022.7.21-27

Similar Articles

№5 / 2023
Malyshkina A.I., Sotnikova N.Yu., Kroshkina N.V., Batrak N.V., Afonina V.A.
The role of fatty acid synthase in the development of fetal macrosomia in women with gestational diabetes mellitys and threatened late miscarriage in the second trimester of pregnancy
№2 / 2021
Palieva N.V., Botasheva T.L., Petrov Yu.A., Pogorelova T.N., Drukker N.A., Levkovich M.A., Gun'ko V.O.
Carbohydrate metabolism and hemostatic system in women with gestational diabetes mellitus, preeclampsia, and fetal growth restriction
№11 / 2023
Postoev V.A., Telkova A.A., Maevskaya P.S., Postoeva A.V., Usynina A.A., Grjibovski A.M.
Pregestational and gestational diabetes mellitus as risk factors for predicting the development of congenital anomalies in newborns
№1 / 2022
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
№8 / 2024
Ignatko I.V., Alieva F.N., Churganova A.A., Rodionova A.M., Romanova E.M., Usman Yz Y., Anokhina V.M., Cherkashina A.V.
Fetal growth restriction in gestational diabetes mellitus: from pathogenesis to management tactics
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.