Maternal Complications Associated with Delivery of Babies Weighing 4500 Grams and Above

Abstract
Background: Fetal macrosomia is delivery of a baby with birth weight of 4000g and above. It is a high risk pregnancy, and it is associated with maternal and fetal complications, especially during delivery.

Objectives: To determine whether delivery of macrosomic babies weighing ≥ 4.5kg results in more maternal complications than babies weighing < 4.5kg. It would also determine the sociodemographic characteristics of the women.

Method and materials: This was an analytic retrospective cross-sectional study of 200 women who delivered macrosomic babies during the study period; 46 babies weighed ≥ 4.5kg, while 154 (macrosomic) babies who weighed < 4.5kg were used as control. Data collected included bio-data, booking status, gestational age at delivery, and birth weight (≥ 4.5kg or < 4.5kg). Data on maternal complications were: episiotomy incision during vaginal delivery, perineal tear (1st, 2nd, and 3rd degree), cervical laceration, estimated blood loss during delivery, and primary postpartum hemorrhage (PPH). Other data retrieved were the mode of delivery, such as: spontaneous vaginal delivery (SVD), caesarean section (CS), and instrumental vaginal delivery (vacuum and obstetrics forceps).

Results: The prevalence of fetal macrosomia was 7.0%, the mean birth weight was 4.30 ± 0.27 kg, the mean maternal age was 31.64 ± 4.0 years, and the mean gestational age (GA) at delivery was 39.7 ± 0.78 weeks Demographic factors that were significantly associated with birth weight ≥ 4.5kg are: Ijaw tribe (p =
0.03), tertiary level of education (P = 0.005), unbooked status (p = 0.02), and postdate (p = 0.0001). Regarding genital tract trauma, the chances of receiving episiotomy incision was 8 times higher among the women who delivered babies weighing ≥ 4.5 grams, odds ratio = 8.31[1.09, 63.19], p = 0.01. Also, the chances of having 2nd degree perineal tear was 5 time higher, odds ratio = 5.17[1.00, 20.60], p = 0.0. The rate of vacuum delivery was increased by 6 folds among women who delivered babies weighing ≥ 4.5kg, odds ratio = 6.14[0.80, 47.23], p = 0.03, and the CS rate by 2 folds, odds ratio = 2.79[1.37, 5.68], p = 0.03. The mean blood loss was significantly higher among women delivered by caesarean section t = 14.9 [396.9, 517.2], p = 0.0001 Conclusion: The maternal complications of fetal macrosomia escalate with increase in birth weight (≥ 4.5kg). Prominent among these are: genital tract trauma, use of instrumental vaginal delivery, and increase in caesarean section rate.

KEY WORDS: fetal macrosomia, birth weight ≥ 4.5kg, maternal complications.