Antenatal - Large for gestational age Flashcards
when are babies defined as large for gestational age? aka macrosomia
- weight of newborn is more than 4.5kg at birth
- estimated fetal weight is above 90th centile
what are some causes of macrosomia?
- constitutional
- maternal diabetes
- previous macrosomia
- maternal obesity or rapid weight gain
- overdue - post maturity
- male baby
macrosomia caries risks for both the mother and the baby. what are some risks to the mother?
- Shoulder dystocia
- Failure to progress
- Perineal tears
- Instrumental delivery or caesarean
- Postpartum haemorrhage
- Uterine rupture (rare)
macrosomia carries some risks to both the mother and the baby. what are some risks for the baby
- Birth injury (Erbs palsy, clavicular fracture, fetal distress and hypoxia)
- Neonatal hypoglycaemia
- Obesity in childhood and later life
- Type 2 diabetes in adulthood
how is macrosomia managed?
- Ultrasound to exclude polyhydraminos and estimate fetal weight
- oral glucose tolerance test for gestational diabetes
- most women will have a successful vaginal delivery - consultant led unit
- paeds input at birth
what is the main risk with macrosomia and how is the risk reduced?
shoulder dystocia
- Delivery on a consultant lead unit
- Delivery by an experienced midwife or obstetrician
- Access to an obstetrician and theatre if required
- Active management of the third stage (delivery of the placenta)
- Early decision for caesarean section if required
- Paediatrician attending the birth
post maturity
>42 weeks
encourage to induce at 42 weeks - if decline regular monitoring
meconium stained liqour - aspiration syndrome
signs in neonate if born post mature - scaphoid abdomen, meconium stained nails and cord, creased subcutaneous skin
problems - IUD, indcution of labour, early of skull fusion, meconium aspiration syndrome
discussion at 37 weeks what would happen i they dont go into labour by 41 weeks
