Optimization of second-stage labor management in fetal macrosomia: A retrospective single-center analysis
DOI:
https://doi.org/10.37800/RM.2.2026.610Keywords:
fetal macrosomia, second stage of labor, operative vaginal delivery, obstetric complications, neonatal traumaAbstract
Relevance: Fetal macrosomia (birth weight ≥ 4000 g) is associated with an increased risk of second-stage labor complications, including prolonged bearing-down, birth trauma, and the need for emergency operative delivery. The optimal duration and management strategy of the second stage in cases of macrosomia remain subjects of ongoing debate.
The study aimed to evaluate the impact of second-stage duration on maternal and neonatal outcomes in cases of fetal macrosomia and to develop practical recommendations for optimizing obstetric management.
Materials and Methods: This retrospective analysis included 15,285 vaginal deliveries at ≥37 weeks of gestation (01.2020-12.2024) at Perinatal Center No.1, Karaganda. Comparison groups: macrosomia (estimated fetal weight ≥ 4000 g, n = 1,456) vs. normosomia (<4000 g, n = 13,829). Evaluated parameters included: second stage-duration, frequency of operative vaginal delivery (OVD), emergency cesarean section, maternal complications (3rd-4th degree perineal tears, blood loss ≥500 ml), and neonatal outcomes (birth trauma, Apgar score, NICU admission).
Results: The average second-stage duration in the macrosomia group was 68.4±22.3 minutes, compared with 54.8±16.2 minutes in the control group (p<0.001). Duration >90 minutes increased the risk of maternal complications by 3.2 times (OR 3.2; 95% CI 2.4-4.3) and neonatal trauma by 2.8 times (OR 2.8; 95% CI 1.9-4.1). OVD in macrosomia was associated with a 5-fold increase in the risk of shoulder dystocia (OR 5.1; 95% CI 2.1-12.4). The optimal duration for bearing down was 75 minutes (sensitivity 71%, specificity 68% for predicting complications).
Conclusion: In cases of fetal macrosomia, active management of the second stage is recommended with reconsideration of the strategy if the duration exceeds 75 minutes, avoidance of routine OVD, and enhanced readiness for obstetric maneuvers.
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