Study of Macrosomic Deliveries in the Gynaecology and Obstetrics Department of the "Major Moussa Diakite" Reference Health Center in Kati, Koulikoro, Republic of Mali

Abstract

The delivery of a macrosomic baby remains a concern for obstetricians and neonatologists, especially when the delivery is vaginal, because of the risk of maternal and perinatal complications. The aim of this article is to study macrosomic deliveries in the gynaecology and obstetrics department of the Kati reference health center. Method: This was a prospective, cross-sectional study which ran from 1 November 2020 to 31 October 2022, a period of 24 months. It concerned all deliveries in which the birth weight of the newborn was greater than or equal to 4000 grams, excluding cases of foetal malformations. Results: Out of a total of 4676 deliveries, we recorded 127 cases of macrosomia, a frequency of 2.7%. The average age of the women was 28.5 years, ranging from 16 to 47 years. The main risk factors identified were high multiparity (29.1%), maternal obesity (28.4%), overdue delivery (19.7%), previous delivery with the presentation was cephalic in 93.7% of cases, and delivery was by vaginal route in 63.8% of cases, compared with caesarean section in 36.2%. Maternal complications were dominated by perineal tears in thirteen cases (10.2%), cervical tears in two cases (1.6%), endometritis in two cases (1.6%), vaginal tears in one case (0.8) and haemorrhage during delivery in one case (0.8%). However, no complications were found in 108 out of 127 deliveries (85%). The Apgar score was less than eight at 1 minute in 12.6% of newborns. We observed serosanguineous hump (8.7%), brachial plexus paralysis (4.7%), clavicle fracture (1.6%) and early neonatal death (2.4%) due to neonatal distress. Conclusion: Macrosomic delivery carries very real risks, and the indications for vaginal delivery must be restricted in order to improve maternal and foetal prognosis.