LGA Flashcards

1
Q

Definition LGA

A

EFW > 90th centile
or
Birth weight > 4kg or >4.5kg

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2
Q

Risks of LGA

A

To baby:

  • Stillbirth, particularly if EFW>5kg
  • Congenital abnormalities
  • Neonatal: Hypoglycaemia, admission to SCBU/NICU, respiratory problems, polycythaemia
  • Later in life- obesity, metabolic syndrome, cardiac remodeling, impaired glucose tolerance

Labour:

  • labour dystocia
  • EMCS for obstructed labour
  • Instrumental delivery
  • Shoulder dystocia
  • Perineal trauma (including OASIS)
  • PPH
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3
Q

Results of 2016 cochrane review for IOL near or at term for macrosomia.

A

Review of 4 trials found-

  • Intervention = IOL 37-40 wks in babies with suspected macrosomia
  • IOL group: reduction in incidence of shoulder dystocia, birth weight and #clavicle but 1 study found increase in 3/4th degree perineal tears.
  • No difference in CS rate, brachial plexus injury rate or instrumental delivery rate.
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4
Q

Risk factors for LGA

A
  • Diabetes – pre-existing or gestational
  • Maternal obesity
  • Maternal weight gain during pregnancy
  • Previous macrosomic baby
  • Male fetus
  • Multiparity
  • Prolonged gestation
  • Ethnicity – Hispanic and white babies are bigger
  • Congenital disorders (genetic syndromes) – eg Beckwith-Wiedemann syndrome, Simpson-Golabi-Behmel syndrome, Sotos syndrome, Weaver syndrome, and Berardinelli lipodystrophia.
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5
Q

What is the definition of LGA?

A

BW > 90th centile

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6
Q

What is the definition of macrosomia?

A

BW >4000g

Excessive intrauterine growth beyond a specific threshold, regardless of gestational age

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7
Q

What are the risk factors for LGA?

A
  • Ethnicity: Samoan, white
  • Genetic syndrome
  • Maternal diabetes, especially poorly controlled
  • Maternal pre-preg weight
  • Excessive GWG
  • Multiparity
  • AMA
  • Post-dates
  • Male
  • Previous LGA
  • Maternal BW > 4000g
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8
Q

What are the maternal complications of LGA?

A
Prolonged labour
Operative vaginal delivery
Caesarean section
Perineal trauma
PPH
Uterine rupture
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9
Q

What are the fetal complications of LGA?

A

Shoulder dystocia leading to birth trauma, brachial plexus injury

Stillbirth. Fetuses >5000g particularly high risk

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10
Q

What are the neonatal complications of LGA?

A
Hypoglycaemia
Respiratory problems
Polycythemia
Minor congenital anomalies
NICU admission (can be prolonged)
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11
Q

What are the implications of LGA on childhood and beyond?

A

Obesity
Impaired glucose tolerance
Metabolic syndrome
Cardiac remodelling

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