The Extremely Large Fetus‐Antenatal Identification, Risks, And Proposed Management

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Abstract
The aim of this study was to evaluate the efficacy of current methods in identifying fetuses with a weight .gtoreq. 5 700 g, and to study the perinatal mortality and morbidity in relation to the mode of delivery. Between 1973 and 1984, 110 newborns in Sweden had a birthweight .gtoreq. 5 700 g. These cases were identified using the National Medical Birth Registry, and from this data base, collecting antenatal, perinatal and infant data since 1973, a reference population was also selected. Tall, parous women with a high pre-pregnancy weight and an abnormal weight gain constituted a high-risk group, but the predictive potential of each of these variables was too low to allow identification of the individual case even in this extremely selected material. The obstetrician generally seemed to be unaware of the possibility of an extemely large fetus and only 7 (6.4%) women were delivered by an elective cesarean section, while 78 (70.9%) gave birth vaginally. Of 8 deaths, 4 were related to shoulder dystocia, which occurred in almost 40% of all women who gave birth vaginally. Eleven newborns, all born vaginally, had a brachial plexus injury. The results of this study favor abdominal delivery for the extremely large fetus.