Large For Gestational Age

Question 1

Macrosomia

Answer 1

More than 4500g at birth

Question 2

Large for gestational age

Answer 2

Estimated fetal weight above the 90th centile

Question 3

Causes of macrosomia

Answer 3

Constitutional

Maternal diabetes

Previous macrosomia

Maternal obesity or rapid weight gain

Overdue

Male baby

Question 4

Complications of macrosomia on the mother

Answer 4

Shoulder dystocia
Failure to progress
Perineal tears
Instrumental delivery or caesarean
Postpartum haemorrhage
Uterine rupture (rare)

Question 5

Complications of macrosomia to the baby

Answer 5

Birth injury (Erbs palsy, clavicular fracture, fetal distress and hypoxia)

Neonatal hypoglycaemia

Obesity in childhood and later life

Type 2 diabetes in adulthood

Question 6

Investigations for a large for gestational age baby

Answer 6

USS - exclude polyhydramnios and estimate the fetal weight

Oral glucose tolerance test for gestational diabetes

Question 7

How to reduce the risk of shoulder dystocia

Answer 7

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