Macrosomia Flashcards
Definition of macrosomia, incidence
4500 g; although some still use 4000 g
Risks increase on continuum after 4000 g
1.5%
Definition of large for gestational age
Greater than 90th percentile for EGA
Risk of shoulder dystocia
without macrosomia 1.5%
with macrosomia 15%
with macrosomia and diabetes 25%
> 50% of dystocias happen without macrosomia
Risk of shoulder dystocia
without macrosomia 0.1%
with macrosomia 5% -> 10% of these are permanent
Risk factors of macrosomia
- history of macrosomia
- maternal obesity
- excessive weight gain in pregnancy
- gestational age > 40 weeks
- positive 1 hr gtt and negative 3 hr gtt
- diabetes mellitus
macrosomia is an indication for….?
not an indication for IOL
- 4500 with diabetes is acceptable indication for CD
- 5000 without diabetes is acceptable indication for CD
How many cesareans need to be performed to prevent 1 permanent brachial plexus injury?
- 1000 cesareans at 5000 g cut off
- 3000 cesareans at 4500 g cut off
what is the risk of shoulder dystocia for diabetic women compared to non-diabetic women?
double at every gestational age
what is the ultrasound sensitivity and specificity for predicting brith weight above 4000 g
56% sensitivity
92% specificity
risks of macrosomia?
maternal: shoulder dystocia, labor abnormalities, c-section, chorioamnionitis (2.4x), PPH (3x), OASIS (2-3x)
fetal:
- depressed 5-minute Apgar scores
- hypoglycemia
- respiratory problems
- polycythemia
- meconium aspiration
- increased rates of admission and prolonged admission (more than 3 days) to a neonatal intensive care unit
what is the sensitivity and specificity of fundal height to predict macrosomia?
sensitivity 20-70%, specificity 90%
interventions to reduce macrosomia?
- exercise during pregnancy (aerobic + strength training)
- control of glucose in diabetics
- pre-pregnancy bariatric surgery in class II/III obesity
