[The macrosomic neonate: incidence, early morbidity and legal aspects. An analysis of the Hessia perinatal study].

In the past 13 years in Hessian Hospitals there is an 20% increase of newborn with a birthweight range between 4000-4499 g and a 17% increase of newborns weigh more than 4499 g. The incidence in the first weight group increases from 7.8% to 9.3% and in the second weight group from 1.3% to 1.53%. Since 1990 the decrease in the incidence of obstetrics traumas in single macrosomic newborns in vertex presentation will be missed, although there was an decrease from 1982 to 1990. There is a statistically significant higher incidence of injuries in the weight group above 4499 g than in the both weight groups below 4500 g. In 13 years the rate of primary Caesarean section only increases in the weight group in the range from 2500 to 3399 g whereas the secondary Caesarean section rate rises in all 3 weight groups. The ratio of an acidosis (ph < 7.10) after vaginal delivery is not different between these 3 newborn groups. After secondary Caesarean section the mean acidosis rate of 5 years (1990-1994) is 2.3% in the normal weight group and 1.5% in the macrosomic newborns. There is no difference in the acidosis rate in the macrosomic newborn groups between vaginal an secondary abdominal delivery. In our opinion the data are no argument for a primary Caesarean section in the weight group above 4499 g. The higher rate of secondary caesarean section and the higher transfer rate of the macrosomic newborns with a birthweight above 4499 g into a neonatal unit represents an elevated perinatal risk. Therefore it will be recommended to send the pregnant women before the beginning of labour in a special obstetrics department in case of estimated birthweight higher than 4499 g according to sonographic examination.