• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Does Suspected Macrosomia Impact Labor Management?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Bushman et al. (American Journal of Perinatology, 2019) investigated whether knowledge of EFW ≥4,000g leads to shortened labor times

METHODS:

  • Secondary analysis of a retrospective cohort study
  • Participants
    • Singleton pregnancies ≥36 weeks
  • EFW determined by
    • Ultrasound (US) within 3 weeks or
    • Physical exam on admission
  • Exclusion criteria
    • Initial cervical exam was ≥6 cm or no attempt was made to labor
    • Comorbidities that would be expected to influence length of labor (e.g., hypertension)
  • Patients were classified as
    • EFW of ≥4,000g
    • <4,000g
  • Primary outcomes
    • Duration of labor
      • Evaluated as total time from 4 cm to delivery (with 4-cm dilation being a surrogate marker for active labor)
      • Length of time allowed from 4 cm until the first documented cervical change (or delivery)
      • Time in second stage of labor (complete dilation to delivery)
    • Cesarean delivery

Note: Active labor defined as >6 cm | 4 cm cut off used because at the research institution, foley is used for patients <4 cm

  • Secondary outcome
    • Arrest of labor

RESULTS:

  • 1,506 patients were included
    • 54 (3.5%) had EFW of ≥4,000g
  • Women with documented EFW of ≥4,000g had greater
    • BMI | Likelihood of induction | Likelihood of an US within 3 weeks of delivery
  • EFW of ≥4,000g was not associated with shortened labor times but was associated with increase risk for cesarean delivery
    • ≥4,000 g: 29.6%
    • <4,000 g: 9.3%
    • Adjusted odds ratio (AOR) 2.7 (95% CI: 1.3 to 5.5)
  • EFW based on US rather than physical exam alone was not associated with shortened labor times but was associated with increased risk for cesarean delivery  
    • Ultrasound: 13.1%
    • External palpitation: 7.9%
    • AOR: 1.5 (95% CI, 1.01 to 2.12)

CONCLUSION:

  • Knowledge of EFW ≥4,000g, especially based on ultrasound diagnosis, is not associated with shortened labor, but is associated with increased risk of cesarean delivery
  • The results of this study suggest that the increased risk for cesarean is not a result of obstetricians shortening labor times because of concern for macrosomia
  • The authors state  

Given these findings an EFW of ≥4,000g by external palpation or US appears to be an independent risk factor for cesarean delivery and can be used to guide labor management accordingly

Learn More – Primary Sources:

Influence of Estimated Fetal Weight on Labor Management

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Macrosomia: Determination of EFW and Recommendations for Delivery
How Accurate are Estimated Fetal Weight Ultrasound Measurements between 23 and 25 Weeks?
Can Fetal Head Size Help Predict Risk of Cesarean Section?
Are New Predictors of Fetal Weight Superior to Traditional Ultrasound?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Download Your ObG App
HERE!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site