Postmaturity and Fetal Macrosomia in Jos, Nigeria

Abstract

Background: One of the risk factors of post term pregnancy is fetal macrosomia. The excessively large infant presents a recurring and potentially serious obstetric problem. Methods:This was a retrospective study of all consecutive births in the maternity unit, Jos University Teaching Hospital, Jos, Nigeria, between January 1998 and December 2001. The case records of all mothers of babies born with weight of 4000g and above were retrieved and data collated and analyzed for total deliveries, maternal and fetal characteristics, complications and outcome of pregnancy. Results:Macrosomic infants (4000g and above) were 286 cases representing 2.9% of all deliveries. Ten (3.5%) of the infants with macrosomia were preterm, 90.9% were term, and 5.6% were post-term. The mean age and parity of the mothers with pregnancies at term was 29.2 years, and 3.2 respectively. The post term mothers had a mean age and parity of 32.7 years and 3.8 respectively. Maternal morbidity included increased caesarean delivery, and vaginal trauma (episiotomies, tears and bruises) in both groups. Caesarean section was the mode of delivery in 31.3% of post term and 27.6% term infants, while the indication for caesarean section was cephalopelvic disproportion in 80% and 87.3% for post term and term infants respectively. Fetal complications were birth asphyxia and stillbirth. There were no gross fetal abnormalities recorded in the series. Still birth rate was 8.1% and 12.5% in term and post term infants respectively. Conclusion: Post term pregnancies account for macrosomic babies in our facility, posing an increased risk to the mother and fetus. Early diagnosis, intrapartum fetal monitoring and recourse to operative delivery may improve the fetal outcome of these infants. A correction to this article has been issued in Annals of African Medicine, Vol. 4, No. 3, 2005, pp. 141. Please see the full text HTML document for further details.Introduction :- L'un des facteurs de risque de la postmaturit\ue9 de la grossesse est la macrosomie foetale. Un enfant qui est excessivement grand provoque un probl\ue8me obst\ue9trique qui est r\ue9current et potentiellement grave. M\ue9thodes : Il s'agit d'une \ue9tude r\ue9trospective de toutes des naissances cons\ue9cutives dans le service d'obst\ue9trique, centre hospitalier universitaire de Jos, Jos, Nig\ue9ria, entre janvier 1998 et d\ue9cembre 2001. Les dossiers m\ue9dicaux de toutes les m\ue8res des enfants n\ue9s avec 4000g poids et de plus ont \ue9t\ue9 tir\ue9s et les donn\ue9es rassembl\ue9es et analys\ue9es pour accouchement total, des caract\ue9ristiques materneles et foetales, complications et le r\ue9sultat de la grossesse. R\ue9sultats : Enfants macrosomiques (4000g et lus) \ue9taient 286 soit 2,9% de tous accouchements. Dix soit 3,5% des enfants avec macrosomie \ue9taient pr\ue9terme, 90,9% \ue9taient terme. Et 5,6% \ue9taient post terme. L'\ue2ge moyen et la parit\ue9 des m\ue8res avec des grossesses \ue0 terme \ue9taient 29,2 ans, et 3,2 respectivement. Des m\ue8res post termes avaient un \ue2ge moyen et une parit\ue9 de 32,7 ans et 3,8 respectivement. Morbidit\ue9 maternelle comprend augmentation d'accouchement c\ue9sarien, et traumatisme vaginal. (\uc9pisiotomies, d\ue9chirures et des blessures l\ue9g\ue8res) dans les deux groupes. La c\ue9sarienne \ue9tait la m\ue9thode d'accouchement en 31.3% des post termes et 27,6% des enfants \ue0 terme, tandis que l'indication pour la c\ue9sarienne \ue9tait c\ue9phatopelvien dispropotionel en 80% et 87,3% pour des enfants post termes et \ue0 terme respectivement. Complications foetales \ue9taient la naissance asphyxie et mort \ue0 la naissance. Il n'y avait aucune abnormalit\ue9 foetale grave not\ue9e dans la s\ue9rie. Taux de mort \ue0 terme et enfants n\ue9s \ue0 post terme respectivement. Conclusion : Grossesses post termes constituent des b\ue9b\ue9es macrosomique dans notre centre. Ceci provoque une augmentation de risque pour des m\ue8res et foetus. Un diagnostique pr\ue9coce, surveillance d'intrapatum foetal et recours au accouchement \ue0 travers l'intervention chirurgicale pourrait am\ue9liorer le r\ue9sultat foetal chez ces enfants