gms | German Medical Science

Background: Making informed choices related to health issues is the right of every user of the health system [1]. Evidence based information (EBI) is the prerequisite for informed choices [2]. Pregnant women in the 3^rd trimester might be confronted with suspected macrosomia diagnosis, which means the baby could be too big. The pregnant women might have to take a decision concerning medical procedures related to the upcoming birth. No user-adapted information which fulfills the standard of evidence-based information, is available in existing literature.

Aim: The Aim was to establish an evidence based information framework regarding the birth management in case of suspected macrosomia in the 3^rd trimester, which fulfills the standards of an EBI and supports pregnant women in informed decision-making.

Methods: A systematic literature search in different databases (e.g. PubMed, Cochrane Library) was conducted related to EBI, macrosomia and information needs of women. Another systematic literature review regarding identified questions was conducted. A critical selection and appraisal of the literature was done, which was used to generate a pilot version. Based on the results of a survey with obstetric health professionals using a questionnaire, a pilot phase with affected pregnant women by a cognitive pretest was undertaken.

Results: Affected women wish a general and early information about options concerning the birth management, reliability of the estimated fetal weight via antenatal ultrasound scan and the risk of morbidity depending on the mode of birth. The sensitivity of identifying a fetus with macrosomia in utero differs between 15%–91% when birth weight is > 4000g. There was 1 trial comparing induction of labour vs. expectant management. There was a significant lower risk of shoulder dystocia (RR 0,47; 95% KI 0,26–0,86) in the intervention group. For all other outcomes there was no clear difference. No evidence for assessing benefits or disadvantages for a planned caesarean vs. induction of labour or expectant management was reported. The EBI was successfully designed and tested). Overall there was a positive feedback on the pilot version.

Discussion: Women's information needs were not evaluated again. Instead, already available information was used. No fee-based translation services were used and only literature in English or German language was eligible for inclusion, which might have led to missing relevant data. The description of the risks provoked fear in pregnant women. The request for accurate and specific percentages could not be fulfilled because of the heterogeneity of the included studies. Fetal risks were interpreted as risks for a vaginal birth only: there need to be strategies to illustrate the risks for both vaginal births and caesarean deliveries.

Relevance: Due to the lack of evidence and the heterogeneous recommendations for the management of birth in case of suspected macrosomia the necessity of an EBI is explicit.

Conclusion: The positive feedback, especially of the target group of pregnant women, is a great success and strength of this work. After adjustment it would be desirable to test the benefits and efficacy of this EBI.

Ethical criteria and conflict of interests: There is no conflict of interest. It was financed from own resources. The research was submitted to an ethics committee.