Large for dates of pregnancy

Question 1

Define Large for dates of pregnancy, how to measure it and RF

Answer 1

Term to identify macrosomic babies - >4kg or 4.5kg -> 10% of pregnancies
3 tools-
1st - symphisis fundal height > 95% centile
2nd - Abdominal cicumference >95%
3rd- estimated foetal weight >95% centile

RF-
high maternal BMI, GDM/DM, molar preg, multiparity
foetal macrosomia, polyhydraminos, advances maternal age
syndrome -beckwith wiedemann, simposon golabi behemel, soto’s

Question 2

Sx and Ix of Large for dates of pregnancy

Answer 2

Sx - inspection - excessive maternal abdo distention for gestational age, increased SFH

Ix = OGTT for GDM
Bloods - bHCG
USS - liquor volume, biometry measurement,
genetic testing

Question 3

Mx of Large for dates of pregnancy

Answer 3

Detected at 18-21w - repeat scan
detected at 24-36w - if accelerate of growth -> USS for foetal biometry
if same path (no drop/fall) - reassure and routine scan + OGTT

detetced at 36-40w- if SFH >90%- USS foetal biometry
if EFW/AC >95% centile -return to routine care
+OGTT
care in labour _ postnatal as per GDM

Question 4

Complications of Large for dates of pregnancy

Answer 4

Shoulder dystocia
Hypoglycemia in GDM
Resp distress syndrome - GDM complications- deliver early
Intrauterine deformation - metatarsus adductus (Foot bend inward), Hip subluxation
Increased mortality
Perinatal tear

Prog - same as normal