Makrozomik Fetuslarda Doğum Şekli Oluşabilecek Komplikasyonları Önler mi?

Öz

Amaç: Bu çalışmada, 4000 gr ve üzerinde bebek doğuran 643 gebenin  doğum şeklinin  ve doğum ağırlıklarının maternal ve neonatal komplikasyonlar üzerine  olan etkisinin değerlendirilmesi amaçlanmıştır.

Materyal metod: 643 hasta doğum şekline (vajinal veya sezaryen) ve doğum ağırlıklarına (4000-4500 ve ≥4500 gram) göre gruplara ayrıldı. 4000 gramın üzerinde doğum yapan hastalar doğum şekline göre komplikasyon oranları açısından karşılaştırıldı. Daha sonra hastalar 4000-4499 gr ve ≥4500 gr doğum yapanlar olarak ayrıldı. Bu iki grubun  kendi içinde komplikasyon açısından fark olup olmadığı araştırıldı.

Bulgular: Makrozomik infant öyküsü, neonatal ağırlık ve eşlik eden DM, sezaryen ile doğum yapan  grupta yüksek saptandı. Neonatal komplikasyonlar açısından herhangi bir fark saptanmadı. maternal postpartum Hb  değeri sezaryen olan grupta anlamlı düşük bulundu. 4500 gramın üzerinde doğan bebeklerin doğum şekli ile komplikasyon oranları değişmezken, 4000-4499 gram arasında postpartum Hb değeri sezaryen olan grupta anlamlı düşük saptandı.

Sonuç: Rutin sezaryen ile doğumun makrozomik infantlarda komplikasyonları azaltma açısından belirgin bir üstünlük sağlamadığı görülmektedir. Makrozomik infant doğurma riski olan hastalar kişiselleştirilmeli ve doğum komplikasyonu açısından risk taşıyan hastalar sezaryene yönlendirilmelidir.

Anahtar Kelimeler

• Makrozomi,komplikasyon,sezaryen

Does type of delivery prevent complications in macrosomic fetuses?

Abstract

Objective: This study aims to analyze the effect of delivery method and birth weight over maternal and neonatal complications in 643 women who gave birth to babies weighing 4000 g or above.

Material method: 643 patients were divided into groups according to their delivery method (vaginal or caesarean) and birth weight (4000-4500 g or ≥4500 g). Patients who delivered babies weighing over 4000 g were compared in terms of complication rates according to their delivery method. Subsequently, groups of patients were compared according to delivery weighing 4000 – 4499 g and ≥4500 g, and were analyzed to find out whether there are differences between in terms of complications.

Results: Macrosomic infant history, neonatal weight and concomitant DM were observed higher in the group of caesarean delivery patients. No difference was found in neonatal complications. Maternal postpartum hemoglobin levels were significantly lower in caesarian delivery group. No difference was found in terms of complication rates between both delivery method groups in babies born over 4500 g, whereas postpartum hemoglobin level was significantly lower in the group of caesarian delivery of babies weighing 4000 – 4499 g.

Conclusion: It is observed that routine caesarian delivery does not provide a significant advantage in reducing complications in macrosomic infants. Women with suspected fetal macrosomia should be individualized  and prophylactic cesarean delivery may be considered for patients who has the risk of delivery complications.

Keywords

• macrosomia,complication,caesarian

Kaynakça

1. 1. Hamilton BE, Martin JA, Osterman MJ, Curtin SC, Matthews TJ. Births: Final Data for 2014. Natl Vital Stat Rep. 2015 Dec;64(12):1-64.
2. 2. Williams Obstetrik, 24 th Edition, Chapter 44 , Fetal growth disorders. page: 872-890
3. 3. Stotland NE, Caughey AB, Breed EM, Escobar GJ. Risk factors and obstetric complications associated with macrosomia. Int J Gynaecol Obstet. 2004 Dec;87(3):220-6.
4. 4. Dan Wang, Li Zhu, Shulian Zhang, Xueqin Wu, Xiaoli Wang, Qin Lv, Dongmei Gan, Ling Liu, Wen Li, Qin Zhou, Jiarong Lu, Haiying He, Jimei Wang, Hua Xin, Zhankui Li, Chao Chen. Predictive macrosomia birthweight thresholds for adversematernal and neonatal outcomes. J Matern Fetal Neonatal Med. 2016 Jan 28:1-24
5. 5. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Practice Bulletin No. 173: Fetal Macrosomia. Obstet Gynecol. 2016 Nov;128(5):e195-e209
6. 6. Peleg D, Warsof S, Wolf MF, Perlitz Y, Shachar IB. Counseling for fetal macrosomia: an estimated fetal weight of 4,000 g is excessively low. Am J Perinatol. 2015 Jan;32(1):71-4
7. 7. Weinert LS. International Association of Diyabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy: comment to the International Association of Diyabetes and Pregnancy Study Groups Consensus Panel. Diyabetes Care 2010;33:e97.
8. 8. Thornton PS, Stanley CA, De Leon DD, et al.; Pediatric Endocrine Society. Recommendations from the Pediatric Endocrine Society for evaluation andmanagement of persistent hypoglycemia in neonates, infants, and children. J Pediatr 2015; 167:238–245

9. 9. Resnik R. Management of shoulder girdle dystocia. Clin Obstet Gynecol 1980;23:559–64.
10. 10. Mohamed Alkahatim Alsammani and Salah Roshdy Ahmed. Fetal and Maternal Outcomes in Pregnancies Complicated with Fetal Macrosomia. N Am J Med Sci. 2012 Jun; 4(6): 283–286.
11. 11. Mbangama-Muela Andy, Mulumba Kapuku Sylvain, Tozin Rahma Rachid, Lumaya Ambis Joëlle, Tandu-Umba Barthélémy, Mbungu Mwimba Roger, Lokomba Bolamba Vicky, Mbanzulu Pita Damien. Trends of Macrosomia at University Clinics of Kinshasa. Open Journal of Obstetrics and Gynecology, 2018, 8, 263-272
12. 12. Alina Weissmann-Brenner, Michal J. Simchen, Eran Zilberberg, Anat Kalter, Boaz Weisz, Reuven Achiron, Mordechai Dulitzky. Maternal and neonatal outcomes of macrosomic pregnancies. Med Sci Monit, 2012; 18(9): PH77-81
13. 13. Engin Oral, Arzu Cağdaş, Altay Geze,r Semih Kaleli, Kiliç Aydinli, Fahri Öçer. Perinatal and maternal outcomes of fetal macrosomia. europian jornal of obstetrics & gynecology and reproductive biology. 2001, Volume 99, Issue 2, Pages 167–171
14. 14. Mbangama-Muela Andy*, Mulumba Kapuku Sylvain, Tozin Rahma Rachid, Lumaya Ambis Joëlle, Tandu-Umba Barthélémy, Mbungu Mwimba Roger, Lokomba Bolamba Vicky, Mbanzulu Pita Damien. Trends of Macrosomia at University Clinics of Kinshasa
15. 15. Chiraz El Fekih, Mechaal Mourali, Nadia Ouerdiene, Seddik Oueslati*, Amine Hadj Hassine, Mounira Chaabene*, Nabil Ben Zineb. Maternal and fetal outcomes of large fetus delivery: A comparative study. La Tunısıe Medıcale - 2011 ; Vol 89 (n°06) : 553 - 556
16. 16. Jıun How Lım, Boon Chong Tan, Ahmad Essa Jammal And E. M. Symonds. Delivery of macrosomic babies: management and outcomes of 330 cases. Journal of Obstetrics and Gynaecology (2002) Vol. 22, No. 4, 370± 374
17. 17. Nassar AH, Usta IM, Khalil AM, Melhem ZI, Nakad TI, Abu Musa AA Fetal Macrosomia (<4500 g): Perinatal Outcome of 231 Cases According to the Mode of Delivery. J Perinatol. 2003 Mar;23(2):136-41
18. 18. Cedergren, M.I. (2004) Maternal Morbid Obesity and the Risk of Adverse Pregnancy Outcome. Obstetrics & Gynecology , 103, 219-224.
19. 19. Weiss, J.L., Malone, F.D., Emig, D., Ball, R.H., Nyberg, D.A., Comstock, C.H., Saade, G., Eddleman, K., Carter, S.M., Craigo, S.D., Carr, S.R. and D’Alton, M.E. (2004) Obesity, Obstetric Complications and Caesarean Delivery Rate—A Population-Based Screening Study. American Journal of Obstetrics
20. 20. Henriksen, T. (2008) The Macrosomic Fetus: A Challenge in Current Obstetrics. Acta Obstetricia et Gynecologica Scandinavica , 87, 134-145.
21. 21. HU Ezegwui, LC Ikeako1, C Egbuji. Fetal macrosomia: obstetric outcome of 311 cases in UNTH, Enugu, Nigeria. Niger J Clin Pract. 2011 Jul-Sep;14(3):322-6.
22. 22. Alsammani MA, Ahmed SR. Fetal and maternal outcomes in pregnancies complicated with fetal macrosomia. N Am J Med Sci. 2012 Jun;4(6):283-6
23. 23. Bryant DR, Leonardi MR, Landwehr JB, Bottoms SF. Limited usefulness of fetal weight in predicting neonatal brachial plexus injury. Am J Obstet Gynecol 1998;179:686–9.
24. 24. Barber EL, Lundsberg LS, Belanger K, Pettker CM, Funai EF, Illuzzi JL. Indications contributing to the increasing cesarean delivery rate. Obstet Gynecol 2011; 118:29–38.25. Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diyabetes mellitus. Am J Obstet Gynecol 2009;200:672.e1–4.
25. 26. JR, Coonrod DV, Russ R, Bay RC. Big infants in the neonatal intensive care unit. Am J Obstet Gynecol 2005;192:1948–53; discussion 1953–5.
26. 27. Modanlou HD, Dorchester WL, Thorosian A, Freeman RK. Macrosomia--maternal, fetal, and neonatal implications. Obstet Gynecol 1980;55:420–4.
27. 28. Yasemin Akın, Serdar Cömert, Cem Turan, Abdülkadir Pıçak, Turgut Ağzıkuru, Berrin Telatar. Macrosomic newborns: a 3-year review. The Turkish Journal of Pediatrics 2010; 52: 378-383
28. 29. Karahanoglu E, Kasapoglu T, Ozdemirci S, Fadıloglu E, Akyol A, Demirdag E, Yalvac ES, Kandemir NO. Risk factors for clavicle fracture concurrent with brachial plexus injury. Arch Gynecol Obstet. 2016 Apr;293(4):783-7.