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Re: fetal macrosomia & induction From: Danny Tucker (obgylist@obsdoc.demon.co.uk) Fri Apr 26 14:31:54 1996 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Malcolm Griffiths: "Re: Induction for macrosomia" Previous message: DoctorJoe@aol.com: "Re: HPV" In reply to: Sara G Shields: "Re: fetal macrosomia & induction" On Thu, 25 Apr 1996, Sara G Shields <Sara.Shields@ummed.edu> wrote: >I agree re: not inducing solely for macrosomia, but how about this >situation: G2P1 at term, previous NSVD at 40 5/7 weeks for 9#3oz >baby, "oh by the way the head came out but the shoulders got stuck", >baby did fine without sequelae, now with EFW by Leopold's 9+, no >diabetes, cervix 2-3cm/50%/ballotable. She REALLY doesn't want to >be induced, and wants as "natural" a labor/delivery as possible, >declined even offer to "strip membranes" at 40 weeks. Ideas? Literature >references? thanks! The predictive value of macrosomia for the occurence of shoulder dystocia (SD) is not good (EFW>4000g PPV 12%[1]). Although macrosomia alone is poorly predictive of SD, I expect the occurence of previous difficulties would add to this individual's risk. This woman clearly wants to be involved in her labour decisions so lay out the ground rules. If she refuses induction, then labour must go your way. Watch out for arrests in labour (both primary dysfunctional and secondary arrest being associated with increased risk of SD [2]) Midpelvic instrumental delivery significantly increases chance of SD, particularly in women with EFW>4000g (*23%* vs 1.2% for spontaneous delivery) [3]. If any of the above occur then I would seriously consider c/s rather than assisted vaginal delivery. Conversely, most SD's can be overcome without trauma to mother and baby and abdominal delivery is not without morbidity (2.6% incidence of birth trauma in infants >4500g delivered abdominally [4]) Pray for a high head at 42 weeks! Regards, Danny 1. Acker D, Sachs B, Friedman E. Risk factors for shoulder dystocia. Obstet Gynecol 1985; 66: 762-8 2. Khatree MHD et al. Features predictive of brachial plexus injury during labour. JA Med J 1982; 61: 232-3 3. Beneditti T, Gabbe S. Shoulder dystocia. Obstet Gynecol 1978; 52: 526-9 4. Spellacy W et al. Macrosomia - maternal characteristics and infant complications. Obstet Gynecol 1985; 66: 158-61 --------------------------------------------------------------------- Dr Danny Tucker --------------------------------------------------------------------- SHO Obstetrics & Gynaecology -- --------------------------------------------------------------------- Nottingham, UK dtucker@obsdoc.demon.co.uk --------------------------------------------------------------------- Next message: Malcolm Griffiths: "Re: Induction for macrosomia" Previous message: DoctorJoe@aol.com: "Re: HPV" In reply to: Sara G Shields: "Re: fetal macrosomia & induction"

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