Birth outcomes in primiparous women diagnosed with fetal macrosomia and managed with active surveillance and watch-and-wait approach

Aim: To compare specific features of delivery in primiparous women diagnosed with fetal macrosomia and managed with the watch-and-wait approach. Materials and methods: The study included 328 primiparous women, who had no carbohydrate metabolism disorders in pregnancy and delivered infants with birth weight 4000-4999 g at 390- 416 weeks of gestation: the active surveillance (pre-induction of labor) was applied to 38 patients at 390-6 weeks of pregnancy; and the watch-and-wait approach (spontaneous delivery and medical indications for induced labor)was applied to 290 patients at 400-6 and 410-6 weeks of pregnancy. Results: The rate of cesarean section was significantly high, when active surveillance was used at 390-6 weeks of pregnancy versus the watch-and-wait approach at 400-6 weeks of pregnancy (55.3% versus 26.8%, p=0.001). Moreover, in the group of women with pre-induction of labor at 390-6 weeks of pregnancy, premature rupture of membranes and low amniotic fluid for a long time (for more than 12 hours) increased the risk of infectious complications, andprophilactic antimicrobial therapy was used to prevent them (p<0,05). The watch-and-wait approach after 41 weeks of pregnancy contributed to increased incidence of chronic fetal hypoxia (p<0.05). Conclusion: The watch-and wait approach used in primiparous women, who had no carbohydrate metabolism disorders and diagnosed with fetal macrosomia before 400-6 weeks of pregnancy allows to decrease the rate of cesarean section and does not increase the incidence of adverse maternal outcomes (perineal trauma, hypotonic bleeding, endometritis) and perinatal outcomes (clavicle fracture, cephalohematoma, neonatal jaundice).

fetal macrosomia, pre-induction/induction of labor, the watch-and-see approach, active surveillance