LGA Flashcards
Definition LGA
EFW > 90th centile
or
Birth weight > 4kg or >4.5kg
Risks of LGA
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
Results of 2016 cochrane review for IOL near or at term for macrosomia.
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.
Risk factors for LGA
- 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.
What is the definition of LGA?
BW > 90th centile
What is the definition of macrosomia?
BW >4000g
Excessive intrauterine growth beyond a specific threshold, regardless of gestational age
What are the risk factors for LGA?
- 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
What are the maternal complications of LGA?
Prolonged labour Operative vaginal delivery Caesarean section Perineal trauma PPH Uterine rupture
What are the fetal complications of LGA?
Shoulder dystocia leading to birth trauma, brachial plexus injury
Stillbirth. Fetuses >5000g particularly high risk
What are the neonatal complications of LGA?
Hypoglycaemia Respiratory problems Polycythemia Minor congenital anomalies NICU admission (can be prolonged)
What are the implications of LGA on childhood and beyond?
Obesity
Impaired glucose tolerance
Metabolic syndrome
Cardiac remodelling