Prediction of birth trauma in delivery of macrosomic fetus

Мочалова Марина Николаевна, кандидат медицинских наук, доцент, заведующая кафедрой акушерства и гинекологии лечебного и стоматологического факультетов ГБОУ ВПО «Читинская государственная медицинская академия», главный акушер–гинеколог Министерства здравоохранения Забайкальского края, Чита.

Пономарева Юлия Николаевна, доктор медицинских наук, кафедры акушерства и гинекологии ГБОУ ВПО «Московский государственный медико-стоматологический университет», Москва.

Мудров Виктор Андреевич, ассистент кафедры акушерства и гинекологии лечебного и стоматологического факультетов ГБОУ ВПО «Читинская государственная медицинская академия», Чита.

Мудров Андрей Андреевич, студент 306 группы лечебного факультета ГБОУ ВПО «Читинская государственная медицинская академия», Чита.

M.N. Mochalova ¹, Y.N. Ponomareva ², V.A. Mudrov ¹, A.A. Mudrov ¹

1Sbei hpe Chita State Medical Academy

2 Sbei hpe Moscow State Medical Dental University

Rational obstetric management strategies for macrosomia is one of the most difficult sections of practical obstetrics because clinical discrepancy remains a leading cause of maternal and fetal injuries, perinatal mortality and infant disability. Prognostical favorable factors for natural delivery of macrosomic fetus are: delivery in history, the gestation period not more than 39 weeks, the symmetric form of macrosomia, alimentary- constitutional obesity not more than first degree, stable glycemia value during the pregnancy (<5.6 mmol/l). One of the most important factors determining the incidence of macrosomic fetus is shoulder dystocia. The ratio of the fetus head size to the biacromial diameter mainly contributes to the development of shoulder dystocia. This ratio may be a criterion for the indication of natural delivery of macrosomic fetus. Thus, the prediction of shoulder dystocia and rational management strategies for macrosomia help to avoids perinatal deaths and significantly reduce birth injuries.

Key words: macrosomic fetus; macrosomia; cephalopelvic disproportion; natal injuries.

Modern research techniques and rational obstetric management strategies for macrosomia have resulted in the decrease in perinatal mortality. However, despite these achievements, the frequency of birth trauma and subsequent disability of newborns are still at the level beyond the standards of the 21^st century. These problems are particularly urgent when decrease in total fertility and difficult economic situation develop in our country [4]. The causes of macrosomia are: mother`s obesity, gestational diabetes, unreasonable and uncontrolled intake of multivitamin complexes and drugs with anabolic effect during pregnancy [4]. Rational obstetric management strategies for macrosomia is one of the most difficult sections of practical obstetrics because clinical discrepancy remains a leading cause of maternal and fetal injuries, perinatal mortality and infant disability. Perinatal morbidity and mortality in macrosomic babies is 1.5 times higher than in birth of fetus with weight less than 4,000 g. Thus, the study of this problem becomes more urgent. One of the most important factors determining the incidence of macrosomic babies is cephalopelvic disproportion - a mismatch between the size of the fetal head and the capacity of the maternal pelvis. The rate of clinically narrow pelvis varies from 1.3 % to 2.9 % of the total number of births and accounts to 10.2 % in the structure of macrosomic baby birth [6].