Erika R Cheng1, Eugene R Declercq2, Candice Belanoff3, Naomi E Stotland4, Ronald E Iverson5. 1. Division of General Academic Pediatrics, Harvard Medical School and Massachusetts General Hospital for Children, 100 Cambridge Street, 1570-B5, Boston, MA, 02114, USA. ercheng@mgh.harvard.edu. 2. Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT430, Boston, MA, 02118, USA. declercq@bu.edu. 3. Department of Community Health Sciences, Boston University School of Public Health, 810 Massachusetts Avenue, CT429, Boston, MA, 02118, USA. cbelanoff@bu.edu. 4. Department of Obstetrics, Gynecology, and Reproductive Science, San Francisco General Hospital, University of California, San Francisco, 3333 California Street, San Francisco, CA, 94118, USA. stotlandn@obgyn.ucsf.edu. 5. Department of Obstetrics and Gynecology, Boston University School of Medicine, 10 Grove Street, East Boston, MA, 02128, USA. Ronald.Iverson@bmc.org.
Abstract
OBJECTIVE: To characterize the prevalence of and factors associated with clinicians' prenatal suspicion of a large baby; and to determine whether communicating fetal size concerns to patients was associated with labor and delivery interventions and outcomes. METHODS: We examined data from women without a prior cesarean who responded to Listening to Mothers III, a nationally representative survey of women who had given birth between July 2011 and June 2012 (n = 1960). We estimated the effect of having a suspected large baby (SLB) on the odds of six labor and delivery outcomes. RESULTS: Nearly one-third (31.2%) of women were told by their maternity care providers that their babies might be getting "quite large"; however, only 9.9% delivered a baby weighing ≥4000 g (19.7% among mothers with SLBs, 5.5% without). Women with SLBs had increased adjusted odds of medically-induced labor (AOR 1.9; 95% CI 1.4-2.6), attempted self-induced labor (AOR 1.9; 95% CI 1.4-2.7), and use of epidural analgesics (AOR 2.0; 95% CI 1.4-2.9). No differences were noted for overall cesarean rates, although women with SLBs were more likely to ask for (AOR 4.6; 95% CI 2.8-7.6) and have planned (AOR 1.8; 95% CI 1.0-4.5) cesarean deliveries. These associations were not affected by adjustment for gestational age and birthweight. CONCLUSIONS FOR PRACTICE: Only one in five US women who were told that their babies might be getting quite large actually delivered infants weighing ≥4000 g. However, the suspicion of a large baby was associated with an increase in perinatal interventions, regardless of actual fetal size.
OBJECTIVE: To characterize the prevalence of and factors associated with clinicians' prenatal suspicion of a large baby; and to determine whether communicating fetal size concerns to patients was associated with labor and delivery interventions and outcomes. METHODS: We examined data from women without a prior cesarean who responded to Listening to Mothers III, a nationally representative survey of women who had given birth between July 2011 and June 2012 (n = 1960). We estimated the effect of having a suspected large baby (SLB) on the odds of six labor and delivery outcomes. RESULTS: Nearly one-third (31.2%) of women were told by their maternity care providers that their babies might be getting "quite large"; however, only 9.9% delivered a baby weighing ≥4000 g (19.7% among mothers with SLBs, 5.5% without). Women with SLBs had increased adjusted odds of medically-induced labor (AOR 1.9; 95% CI 1.4-2.6), attempted self-induced labor (AOR 1.9; 95% CI 1.4-2.7), and use of epidural analgesics (AOR 2.0; 95% CI 1.4-2.9). No differences were noted for overall cesarean rates, although women with SLBs were more likely to ask for (AOR 4.6; 95% CI 2.8-7.6) and have planned (AOR 1.8; 95% CI 1.0-4.5) cesarean deliveries. These associations were not affected by adjustment for gestational age and birthweight. CONCLUSIONS FOR PRACTICE: Only one in five US women who were told that their babies might be getting quite large actually delivered infants weighing ≥4000 g. However, the suspicion of a large baby was associated with an increase in perinatal interventions, regardless of actual fetal size.
Entities:
Keywords:
Labor induction; Mode of delivery; Suspected macrosomia
Authors: Suneet P Chauhan; William A Grobman; Robert A Gherman; Vidya B Chauhan; Gene Chang; Everett F Magann; Nancy W Hendrix Journal: Am J Obstet Gynecol Date: 2005-08 Impact factor: 8.661
Authors: D Sadeh-Mestechkin; A Walfisch; R Shachar; I Shoham-Vardi; H Vardi; M Hallak Journal: Arch Gynecol Obstet Date: 2008-02-26 Impact factor: 2.344