ACCOUCHEMENT DU MACROSOME

Introduction : 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. Material and methods : We describe results of a retrospective study of 438 cases of confinement of newborn weighing 4000g or more, in our department through one year period, fron 1 January till 31 december 2007. Discussion : Frequency was of 6,5%, maternal age >30 years old in 59% of cases, mothers average weight was over 80kg 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% of 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 distriss, a brachial plexas palsy in one case, and brachial plexus stretch in one case, fructure clavicle in one case, 3 cases of respiratory distress and one case of neonatal Jaundice. 17 cases were transfered to different pediatrics departments. The main observed maternal complications were represented by : 6 cases of postpartum hemorrahge, 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. Conclusion : By an apropriate 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.