ABSTRACT
Management of fetal macrosomia is a situation that obstetricians are often faced. Independently of its etiology, the macrosomian exposed to major complications, dominated during delivery by the risk of shoulder dystocia, which is rare but dramatic situation, requiring the presence of a trained obstetrician ready to cope. We describe results of a retrospective study of 438 cases of confinement of newborn weighing 4000g or more, in our department trough one year period, from 1 January till 31 December 2007. Frequency was of 6.5%, maternal age >30 years old in 59% of cases, mothers average weight was over 80 kg in 56%. A family history of diabetes was found in 18.7%, primiparous was 31% while multiparity was 35%. The diagnosis of macrosomia has been suspected and identified only prior to work in 15.75%. Caesarean section was licited in 30% cases. The complications following vaginal delivery were shoulder dystocia in 22 cases. The neonatal complications were noted in 44 cases, they were represented by: hypoglycemia at birth [7%], 6 cases of acute foetal and one case of neonatal Jaundice. 17 cases were transferred to different pediatrics departments. The main observed maternal complications were represented by: 6 cases of postpartum hemorrhage, cervical tears in 12 cases, 21 vaginal tears and 16 cases of perineal tears, no case of uterine rupture or maternal death has been reported. By an appropriate management during macrosomic vaginal delivery, close monitoring and directed the work with a good command of obstetric maneuvers, we can reduce the risky associated with this delivery and woke it as a mangeable delivery of a non-macrosomic newborn