Extreme XXXX - Obstetric outcomes and complications in birthweights >5000  g.

@entity1 @entity398 @entity174 @entity1266 @entity5300 @entity8455
OBJECTIVE: Management of extremely large birthweight @entity1 presents challenges during the period of labour and delivery. We sought to examine outcomes in @entity1 with extreme @entity8455 (birthweight  >  5000  g), at an institution where the management of labour is standardised. MATERIALS AND METHODS: This is a retrospective analysis of prospectively gathered data on all @entity1 with a birthweight >5000  g delivered at a tertiary level institution from 2008 to 2012. Details of labour characteristics and outcomes were examined; these were compared according to parity. RESULTS: During the study period, there were 46  128 deliveries at the hospital and 182 @entity1 with a birthweight >5000  g, giving an incidence of 0.4%. The majority of @entity1 (133/182) were multiparous. Among nulliparas, 47% (23/49) had a vaginal delivery, while 53% (26/49) had a caesarean delivery. 86% (97/113) of multiparas had a vaginal delivery, and 14% (16/113) had a caesarean delivery. 43% (69/162) required induction of labour. This was more common in nulliparous compared with multiparous @entity1 (58% [29/49] vs 30% [40/133], P  =  0.005, OR  =  3.4, 95% CI  =  1.7-6.6). A total of 30% (49/162) of @entity1 had their labour accelerated with @entity398 . There were higher rates of @entity398 use in nulliparas than in multiparas (55% [27/49] vs 16.5% [22/133], P  <  0.0001, OR  =  6.2, 95% CI  =  3-12.8). Seventeen of the 120 @entity1 delivered vaginally had a shoulder @entity1266 (14.2%), with three suffering an @entity5300 , all of which had resolved before 6  months of age. One baby had a @entity174 . CONCLUSION: Extreme @entity8455 affects 0.4% of pregnancies in contemporary practice. Multiparas have a low rate of caesarean section. @entity1 delivered vaginally are at increased risk of shoulder @entity1266 and associated complications.
