Prophylactic cesarean delivery for fetal macrosomia diagnosed by means of ultrasonography—A Faustian bargain?

Both our previously performed decision analysis and more recent clinical data considered in the context of our decision analytic framework support the claim that in the pregnancies of women without diabetes the level of intervention and the economic costs of prophylactic cesarean delivery for fetal...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 1999-08, Vol.181 (2), p.332-338
Main Authors: Rouse, Dwight J., Owen, John
Format: Article
Language:English
Subjects:
Biological and medical sciences
Birth Injuries - prevention & control
cesarean delivery
Cesarean Section - economics
Cesarean Section - statistics & numerical data
Diseases of mother, fetus and pregnancy
Dystocia - prevention & control
Female
Fetal Macrosomia - diagnostic imaging
Gynecology. Andrology. Obstetrics
Humans
macrosomia
Medical sciences
Pregnancy
Pregnancy. Fetus. Placenta
Shoulder
Ultrasonography
Ultrasonography, Prenatal
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Summary:Both our previously performed decision analysis and more recent clinical data considered in the context of our decision analytic framework support the claim that in the pregnancies of women without diabetes the level of intervention and the economic costs of prophylactic cesarean delivery for fetal macrosomia diagnosed by means of ultrasonography are predicted to be excessive. Under the most plausible assumptions, a prophylactic cesarean policy with either a 4000- or 4500-g macrosomia threshold would require more than 1000 cesarean deliveries and millions of dollars to avert a single permanent brachial plexus injury. In the pregnancies of diabetic women, although such policies would be expected to perform appreciably better, their use would nevertheless entail considerable intervention for any benefit achieved. Under most assumptions, hundreds of cesarean deliveries and hundreds of thousands of dollars would be required to avert a single permanent brachial plexus injury. In light of the available data, optimizing the management of shoulder dystocia seems at present to be the most immediate and tenable approach to the prevention of birth-related brachial plexus injury. (Am J Obstet Gynecol 1999;181:332-8.)
ISSN:0002-9378
1097-6868
DOI:10.1016/S0002-9378(99)70557-0