Risk in the vaginal delivery of the large fetus.

The problem of the excessively weighted fetus was studied. For this purpose, over a period of 2 years, each delivery with fetal weight of 4,500 g or more was included in the study. The history and examination findings of the present pregnancy were reviewed following delivery. The postpartum outcome and later complications in both mothers and infants were investigated prospectively. A total of 82 deliveries of large babies were included in the study and the outcome was compared with that of parallel deliveries of babies within the normal weight range (2,500-4,000 g). Factors frequently associated with excessive fetal weight were identified. A relatively high perinatal mortality and morbidity relating to vaginal delivery were observed among the large infants. In all those cases who developed delay in the second stage of labour, Caesarean section is proposed when macrosomia is clinically suspected and confirmed by ultrasonic assessment. Moreover elective Caesarean section should be considered before labour, when macrosomia is associated with hyperglycaemia or other pathology.