RESUMO
OBJECTIVE: To determine the prevalence of obstetric, perinatal and neonatal complications associated with foetal macrosomia at Holberton Hospital in Antigua. DESIGN AND METHODS: The study included all babies of birthweight (BW) >4.5 kg, born between July 1991 and January 1997, and all babies with BW >4.0 kg, born between July 1991 and January 1995. Control babies were selected from those born on the same day as index cases. RESULTS: Babies of BW >4.0 kg were 5.7 percent of total, BW >4.5 kg, 1 percent. Records were complete on 157 large babies (40 with BW >4.5 kg) and 157 control babies <4.0 kg. Mothers of large babies were significantly older (27.9 vs 26 yrs, p<0.02), more parous (3.5 vs 3, p<0.05), had diabetes (7.7 percent vs 1.9 percent, p<0.02), hypertension (6.3 percent vs 1.9 percent, p<0.05), and delivered after 40 weeks' gestation (39 percent vs 22 percent, p<0.001). At delivery, mothers of large babies were more likely to bleed (>500 ml, 22 percent vs 11 percent, p<0.001). Mean BW in large babies was 4.312 vs 3.136 g (p<0.001) in controls. Large babies had lower 1 min (6.9 vs 7.5, p<0.01) and 5 min (8.3 vs 8.9, p<0.05) apgar scores, were meconium stained (10.2 percent vs. 3.8 percent, p<0.01), had respiratory distress (4.5 percent vs 0.6 percent, p<0.05), birth trauma or dystocia (3.8 percent vs 0.6 percent, p<0.01), went to Special Care (23.5 percent vs 14 percent, p<0.05) more often. There was no difference in Caesarean section rate, hospital days, neonatal jaundice or mortality. Babies with BW >4.5 kg had mortality of 7.5 percent vs 1.8 percent for those <4.5 kg. CONCLUSIONS: Foetal macrosomia remains a difficult obstetrical problem associated with significant maternal, perinatal, and neonatal consequences. Morbidity and mortality are still significant in developed and developing countries alike.(Au)
