[32] Large for Gestational Age Flashcards

1
Q

What is LGA often defined as?

A

Weight, length, or head circumference that lies above the 90th centile for that gestational age

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2
Q

What term is sometimes used for LGA?

A

Macrosomia

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3
Q

What is macrosomia defined as?

A

A baby bigger than 4kg at birth, regardless of gestational age

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4
Q

When are the risks associated with fetal macrosomia significantly increased?

A

When the birth weight is over 4.5kg

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5
Q

What is one of the main risk factors for macrosomia?

A

Poorly controlled diabetes, including gestational diabetes and pre-existing type 2 diabetes

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6
Q

What is pre-existing type 1 diabetes associated with?

A

More associated with SGA

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7
Q

What % of cases of macrosomia are caused by uncontrolled diabetes?

A

35-40%

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8
Q

What are other risk factors for macrosomia?

A
  • Post-term pregnancy
  • Maternal obesity
  • Multiparity
  • Prior macrosomic infant
  • Male infant
  • Increased maternal height
  • Advanced maternal age
  • Beckwith-Wiedemann syndrome
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9
Q

What % of cases of macrosomia are associated with post-term pregnancy?

A

10-20%

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10
Q

What % of cases of macrosomia are associated with maternal obesity?

A

10-20%

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11
Q

What is used to detect LGA?

A

Ultrasound

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12
Q

What is the limitation of using ultrasound to diagnose LGA?

A

Current ultrasound techniques are only accurate to within 15-20% of fetal weight

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13
Q

What should be done for women at high risk of having a macrosomic infant, or have a known LGA fetus?

A

Should be followed with serial ultrasound examinations every 3-4 weeks to chart fetal growth

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14
Q

What might be offered for delivery of a macrosomic infant?

A

Elective C-section

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15
Q

What is the purpose of elective C-section for the delivery of a macrosomic infant?

A

To prevent birth trauma

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16
Q

When should elective C-section be offered to women with a macrosomic baby?

A
  • EFW of >4500g in diabetic women

- EFW of >5000g in non-diabetic women

17
Q

How should vaginal delivery of a macrosomic infant take place?

A

In a controlled fashion, with immediate access to anaesthetic staff and neonatal resuscitation team

18
Q

What are the maternal risks of LGA?

A
  • Labour problems
  • Genital tract lacerations
  • Post-partum haemorrhage
  • Uterine rupture
  • Higher incidence of C-section delivery
19
Q

What labour problems are at increased risk in LGA?

A
  • Obstructed labour

- Instrumental delivery

20
Q

Why is there an increased risk of post-partum haemorrhage with LGA?

A

Increased risk of uterine atony

21
Q

What are the fetal risks of LGA?

A
  • Increased risk of intrauterine and neonatal death
  • Neonatal hypoglycaemia
  • Birth injury
  • Talipes
22
Q

Give 2 birth injuries that LGA babies have higher risk of

A
  • Shoulder dystocia

- Brachial plexus palsy