Delivery in fetal macrosomia. A review

Shoulder dystocia is an unpredictable obstetric emergency that may result in injury to the mother or fetus. The literature review shows that even the combination of obstetrical histories, prenatal risk factors and estimated fetal weight is ineffective in prospectively identifying infants whose births are complicated by dystocia of the shoulder. Exact fetal weight estimation in macrosomia remains an unsolved problem. Some formulae are better than others but none reaches an acceptable detection and positive rate in screening for macrosomia that could lead to clinical recommendation. Among babies born with macrosomia, in utero identification did not improve neonatal or maternal outcomes. Induction of labor for suspected macrosomia has not been shown to modify the incidence of shoulder dystocia among non diabetic women and the concept that prophylactic caesarean delivery as a means to prevent shoulder dystocia and avoid brachial plexus injury has not been supported by clinical data. Optimizing the management of shoulder dystocia seems actually to be the most immediate and useful approach to the prevention of birth-related brachial plexus injury. © 2013 Copyright, CIC Edizioni Internazionali, Roma.