Impact of fetal macrosomia on the course of childbirth and maternal and neonatal prognosis in the obstetric gynecology department of the Ignace Deen university hospital in Conakry.

Abstract

Objective: The aim of this study was to evaluate the impact of fetal macrosomia on the course of childbirth and maternal and neonatal prognosis. Methods: This was a prospective, analytical cohort study of six 6-month duration (July 12, 2021 to January 11, 2022) carried out at the maternity ward of the Ignace Deen National Hospital on parturients carrying a macrosomic or non-macrosomic fetus and their newborns. Results: Of the 3068 deliveries recorded, 138 involved macrosomic fetuses, representing a frequency of 4.5%. The risk of shoulder dystocia was 9 times higher in cases of macrosomia (Relative Risk=9.3 [2.7- 31.9] p=0.00), the risk of caesarean section was multiplied by 2.8 (Relative Risk =2.8 [2.2-3.6], p=0.01) and that of instrumental extraction by 5.5 (Relative Risk =5.5 [1.8-17.0] p=0.00). Perineal tears were 4 times more frequent in macrosomic babies (Relative Risk =4.3 [1.9-9.6] p=0.00) and post-partum haemorrhage 5 times more frequent (Relative Risk =5.0 [3.6-6.9] p=0.00). Macrosomic newborns had an
80% increased risk of po or first-minute Apgar score (Relative Risk =1.8-1.8 [1.3-2.6], p=0.00), a 90% increased risk of resuscitation (Relative Risk =1.9 [1.2-3.1] p=0.00) and a 3.6-fold increased risk of stillbirth (Relative Risk =3.6 [1.2-10.5] p=0.00). Conclusion: Macrosomal delivery is frequent in our labor context, with a high frequency of dystocia, maternal and neonatal morbidity and stillbirth.