Different definition than LGA wt gt90 th percentile for GA Evidence Ultrasound is not good predictor of EFW Physical examination is noninferior to US Consider combining both Risk Factors ID: 921066
Download Presentation The PPT/PDF document "MACROSOMIA Actual birth wt. > 4,000 g" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
MACROSOMIA
Actual birth wt. > 4,000 g
*Different definition than:*
LGA wt. >90
th
percentile for GA
Slide2Evidence
Ultrasound is not good predictor of EFW
Physical examination is non-inferior to U/S
?Consider combining both
Slide3Risk Factors
Maternal BMI
Maternal hyperglycemia, gestational diabetes
Dyslipidemia/Hyperlipidemia
Post-dates
Gestational age
Excessive gestational weight gain
Previous birth to newborn >4,000g (single greatest RF)
Maternal birth weight
Slide4Complications
Maternal:
increased risk of Caesarian birth;
postpartum hemorrhage;
chorioamniotis
vaginal lacerations
Fetal:
shoulder dystocia and subsequent clavicle fractures and/or brachial plexus injuries;
depressed APGAR scores at 5 minutes;
hypoglycemia
and more.
Slide5Counseling
Focus on the positives (mother/family might be scared)
Pregnant women with suspected macrosomia should be provided individualized counseling about risks and benefits of vaginal birth v c sec
Insufficient evidence to suggest induction of labor in patients before 39 0/7 weeks (
this article only
looked at Macrosomia – in practice, if unable to achieve tight glucose control – may consider inducing
at 39wks)
Slide6Preventions
Aerobic Exercises (or combination of Aerobic & Anaerobic)
Tight Glucose control
Fasting Bd. Sugar
better correlates with risks of fetal macrosomia
Slide7Mitigation & Preparedness
Diabetes + EFW >4500g -> recommend c-section
EFW >5,000g -> recommend c-section
Insufficient evidence to suggest induction of labor in patients before 39 0/7 weeks
Protocol used at UNM MCH for mothers with LGA – includes blood sugar testing for infant