Assistência ao parto na macrossomia fetal

OBJECTIVES: to evaluate delivery assistance in fetal macrosomia. METHODS: this was a hospital-based cohort study of consecutive births at a tertiary perinatal center from January 1, 1996 to October 31, 1999. A total of 5261 pregnancies met the inclusion criteria which were singleton pregnancies with minimal birth weight of 1000 g. Fetal macrosomia was defined as birth weight of 4000 g or more. We studied the mode of delivery, the newborn condition at birth, considered low when the Apgar scored below seven in the first or fifth minute, and the presence of abnormalities that could indicate a Caesarian section (disproportion, uterine dysfunction, prolonged second period of birth and fetal distress). RESULTS: 296 (5,6%) of the babies were macrosomic. Macrosomia was a risk factor for Caesarian section (RR = 1,59, p <0,001) and for operative vaginal delivery RR = 1,12 (p <0,001). Newborn conditions was not worse in macrosomic babies. There was a positive correlation between fetal macrosomia and disproportion but not with uterine dysfunction, prolonged second period of birth or fetal distress. CONCLUSIONS: caesarian section was indicated more often for macrosomic babies, but our data did not suggest that a more extensive use of C-Sections was justified.OBJETIVOS: avaliar a assistência ao parto na macrossomia fetal. MÉTODOS: Estudo do tipo coorte realizado em centro perinatal terciário no período de 1 de janeiro de 1996 a 31 de outubro de 1999. Foram selecionadas 5261 gestações de acordo com os critérios de inclusão, que foram: gestação única e peso mínimo ao nascimento de 1000 g. A macrossomia fetal foi definida como peso ao nascimento acima de 4000 g. Estudamos a via de parto, as condições ao nascimento, Apgar baixo quando inferior a sete no primeiro e quinto minutos e as anormalidades que serviram de indicação para cesariana (desproporção, distocia uterina, segundo período prolongado e sofrimento fetal). RESULTADOS: 296 (5,6%) dos conceptos eram macrossômicos. Macrossomia foi fator de risco para cesariana (RR = 1,59, p <0,001) e para parto operatório vaginal (RR = 1,12 p