Prevalência de recém-nascidos macrossômicos e as complicações maternas e neonatais em partos acompanhados na maternidade Otto Cirne do Hospital das Clínicas - UFMG em Belo Horizonte no período de 2014 a 2019

Abstract

Objectives: Evaluate the incidence of macrosomic newborns (weighting at least 4000 grams of birth weight) at the Otto Cirne maternity of the Hospital das Clínicas-UFMG in Belo Horizonte from 2014 to 2019, as well as the maternal characteristics involved, risk factors, mode of delivery and associated complications. Methodology: This is an observational crosssectional, retrospective study carried out by searching for data in the UFMG Hospital das Clínicas’ own system (SISMASTER) and clinical records. The statistical analysis of the variables collected included both simple descriptive analyzes – such as averages and proportions – as well as inferential statistics, such as confidence intervals and hypotheses tests for the associations between the independent variables and response variables (outcome). Results: From 2014 to 2019, 3.3% of deliveries at the Otto Cirne Maternity Hospital were macrosomic newborns. The average age of the patients was 28.6 years, with an average gestational age of 39.4 weeks. The vast majority of women (77%) were multiparous. The most common mode of delivery (65%) was cesarean section, of which 70% were elective cesarean sections. Diabetes mellitus was present in 30% of the deliveries studied (13% already had diabetes when they became pregnant, 59% were diagnosed with gestational diabetes mellitus according to the criteria at the time, and another 28% were not diagnosed during prenatal care, but would be diagnosed with diabetes mellitus by the current criteria). Glycemic control was absent in most patients. Among the vaginal deliveries, only 6% were instrumented. There was shoulder dystocia in 21% of the cases. Of the adverse outcomes for the puerperal woman, laceration occurred in 73% of vaginal deliveries, but in only 5% these lacerations were severe (3rd and 4th degrees). There was a need for episiotomy in 24 cases (18%). Increased puerperal bleeding occurred in 70 patients (19%) of the total sample. The majority (62%) of newborns had some complication, with jaundice (35%) being the most common and birth trauma the least common (3%). Conclusion: Birth weight above 4000 grams had a significant impact on the occurrence of neonatal complications, such as hypoglycemia, respiratory distress and 5th minute APGAR less than 7, especially if birth weight was above 4500 grams. Gestational age was also shown to be statistically significantly associated with neonatal complications, the lower, the greater the risk. The study did not find evidence for a direct association between birth weight and the occurrence of shoulder dystocia or birth trauma, it showed a negative association between birth weight and the occurrence of 3rd and 4th degree lacerations, probably because the analyzed sample included only cases of extreme weights. Episiotomy and increased puerperal bleeding were directly associated (negatively) with multiparity. In view of the results found, it can be concluded that macrosomia is strongly linked to complications, especially neonatal complications, and that further studies are necessary to improve the discussion about the mode of delivery in cases of macrosomic newborns. Studies comparing samples of newborns weighing below and above 4000 grams can provide more information.