Large for Gestational Age

Question 1

What is Large for Gestational Age aka?

Answer 1

Macrosomia

Question 2

What weight of a baby is considered Large for GA?

Answer 2

4.5+ kg @ birth

Question 3

What is considered Large for GA during pregnancy?

Answer 3

Above 90^th percentile for GA

Question 4

What are the causes of Large for GA? (6 things)

Answer 4

1. Constitutional (aka normal jus big like der fam)
2. Maternal DM
3. Previous Large for GA
4. Maternal obesity
5. Overdue (obv)
6. Male baby (obv lol)

Question 5

What are the Risks to MOTHER from Large for GA? (6 things)

Answer 5

1. Shoulder dystocia (main one)
2. Failure to progress
3. Perineal tears
4. Instrumental delivery / C section
5. PPH
6. Uterine rupture (rare)

Question 6

What are the Risks to BABY from Large for GA? (4 things)

Answer 6

1. Birth injury (e.g Erbs palsy / Clavic # / Foetal distress / Hypoxia)
2. Neonatal hypoglycaemia
3. Obesity @ childhood / later life
4. T2DM @ adulthood

Question 7

What investigations should you for a Large for GA baby? (2 things)

Answer 7

1. US
2. Oral glucose tolerance test (for Gestational Diabetes)

Question 8

What is the point of US in Large for GA investigation? (2 things)

Answer 8

1. Exclude Polyhydramnios
2. Estimate Foetal weight

Question 9

Will most women with Large for GA have a normal vaginal delivery?

Answer 9

Yes

Question 10

How can the risks of Large for GA be reduced? (4 things)

Answer 10

1. Deliver on a Consultant Lead Unit
2. Delivery by XP midwife / obstetrician
3. Early decision for C section if req
4. Paediatrician attending birth