Two hundred eighty-four macrosomic babies of 4000 g or over at birth were compared with an equal number of appropriate weight term infants, to identify maternal risk factors and fetal outcome. Maternal obesity, grand multiparity, diabetes mellitus and postmaturity were the major maternal risks. Prolonged labor, shoulder dystocia and injury to infant following instrumental delivery for mid-cavity arrest were the major fetal risks. A protocol for management of fetal macrosomia is proposed.

A retrospective analysis of 646 Arab grandmultiparas who booked for hospital confinement between 1983 and 1985 was carried out. The results were compared with that of non-grandmultiparas during the same period. In the grandmultiparas, the incidences of gestational diabetes, hypertension rheumatic heart disease, antepartum, postpartum hemorrhage and macrosomic infants were increased. However, contrary to some previous reports the incidences of anemia, cesarean sections, induced labor, dysmaturity and perinatal deaths were decreased. This is thought to be due to the provision of modern specialist perinatal care and improved socioeconomic standards.

A detailed radiologic and anatomic study of a 20-week-old fetus is presented. In addition to conventional radiography, various contrast medium injection techniques were used. The findings were followed up at autopsy. The fetus showed multiple congenital abnormalities comprising phocomelia, horseshoe lung, horseshoe kidney, urethral stenosis with megacystis, bilateral hydronephrosis, hydrourcters, imperforate anus, and a single tracheo-esophageal tube· (persistent esophago-trachea). The association of horseshoe lung with persistent esophago-trachea, microurethra, megacystis, bilateral hydroureters, hydronephrosis and phocomelia is, we believe, the first ever to have been recorded in the literature. Twenty-one cases of horseshoe lung have been reported in the literature. These cases were reviewed and a comparison with the present case is presented. The embryologic basis for these anomalies is also briefly discussed.

Sixty-two cases of transverse lie were studied, with an average incidence of 1:250. The different etiologic factors predisposing to transverse lie are discussed, and the medical literature is reviewed. Antenatal management and management at term are also discussed.