Mode of delivery and birth complications in fetal macrosomia: a simple cost-effectiveness analysis

Aim: To evaluate the effect of delivery route on birth complications and related costs in fetal macrosomia ( 4000 g). Materials and methods: Patient and newborn hospital records of 365 macrosomic deliveries (≥4000 g) were retrospectively analyzed. Of these deliveries, 189 newborns weighed between 4000 and 4249 g (Group I), and 176 were between 4250 and 4500 g (Group II). The effects of mode of delivery on birth complications were evaluated and a simple cost-effectiveness analysis was performed. Results: There was no statistical difference between the 2 groups concerning birth complications, except dystocia and episiotomy hematoma. The rate of dystocia was found to be significantly higher in Group II than in Group I (14.1% versus 3.8%, respectively; P = 0.040). Similarly, episiotomy hematoma was found to be significantly higher in Group II than in Group I (18.8% versus 3.8%, respectively; P = 0.004). As opposed to similar rates of serious and permanent complications, mild or moderate temporary maternal and fetal complications were seen to be higher in vaginal births of infants weighing more than 4250 g (P = 0.001 and P = 0.024, respectively). In macrosomia, the total cost of a cesarean section (C/S) was almost 2 times higher than the cost of a vaginal delivery per patient (937 Turkish liras versus 491 Turkish liras, respectively). Conclusion: C/S was not related with favorable maternal or newborn outcomes, and it was not a cost-effective option in patients with fetal birth weights between 4250 and 4500 g.