MODERN ASPECTS OF OBSTETRIC TACTICS FOR FETAL MACROSOMIA


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Abstract

Fetal macrosomia occurs in about 10% of all pregnancies, tends to increase constantly, and is often associated with an increased risk of maternal and perinatal complications. Despite the relatively high incidence of fetal macrosomia, many aspects of management and delivery in this category of pregnant women are controversial. Some authors adhere to expectant tactics, while others prefer active strategies (early pre-induction/induction of labor or planned cesarean section). Questions remain about the impact of early pre-induction/induction of labor on the risk of cesarean section and perinatal morbidity in patients with suspected fetal macrosomia. The lack of generally accepted obstetric tactics has the reason for determining the purpose of our study, namely, to assess the data available in Russian and foreign literature on the methods and terms of delivery of pregnant women with fetal macrosomia, depending on their existing carbohydrate metabolism disorders. The analysis of the data available in the literature and the results of previous studies have shown that there is a need to elaborate Russian clinical guidelines for the management of pregnant women with fetal macrosomia, the introduction of which will be able to facilitate the decision-making process when choosing obstetric tactics, as well as to reduce the rates of cesarean section and maternal and perinatal complications. Conclusion: Future investigations should aim at clarifying the optimal timing of pre-induction/induction of labor and the method of delivery for women without diabetes and fetal macrosomia, taking into account their parity and history. Increasing the accuracy of diagnosing the estimated fetal weight remains one of the priority tasks for an obstetrician/gynecologist, the solution of which will lead to a decrease in the rate of planned caesarean section and to inappropriate labor induction.

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About the authors

Victoria A. ODINOKOVA

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: v_odinokova@oparina4ru
postgraduate student Moscow, Russia

Roman G. SHMAKOV

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: r_shmakov@oparina4ru
Dr. Med. Sci., Professor of the RAS, Head of the Institute of Obstetrics Moscow, Russia

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