Macrosomia

Question 1

Difference between macrosomia and LGA?

Answer 1

Macrosomia: infant with birth weight >4500g

LGA: fetal growth in excess of 90th percentile at ANY gestational age

Question 2

At what EFW would offering a C-section be reasonable?

Answer 2

5000g if no DM, 4500g if DM

Question 3

A 28-year-old woman, gravida 2, para 1, comes to the office for a routine prenatal visit at 38 weeks of gestation. She started her pregnancy at a normal weight for her height and has gained 8.2 kg (18 lb) to date. Her first child was delivered vaginally at 39 weeks of gestation and weighed 3,750 g. Her 1-hour glucose tolerance test is normal. Her blood pressure is 110/70 mm Hg with a normal urinalysis. On physical examination, the fundal height is 39 cm and Leopold maneuvers suggest an infant in cephalic presentation that weights approximately 3,860 g (8.5 lb). The fetal heart rate is 130 beats per minute. Her cervix is closed, long, and firm. Ultrasonography shows a singleton pregnancy in cephalic presentation with an estimated fetal weight of 4,110 g (9 lb). The best next step in management is:

(A) cesarean delivery at 39 weeks 
(B) expectant management
(C) immediate cesarean delivery 
(D) immediate induction of labor 
(E) induction of labor at 39 weeks

Answer 3

(B) expectant management