Fetal Macrosomia
Macrosomia is a fetus with estimated fetal weight (EFW) >90−95 th percentile for gestational age. Birth weight ≥4,000−4,500 grams.
- Sonogram estimated fetal weight(EFW) Accuracy in estimating birth weight is poor. Errors in prediction of EFW at term are ±400 grams.
Risk Factors:
- Gestational diabetes mellitus
- overt diabetes
- prolonged gestation
- increase in BMI (obesity)
- increase in pregnancy weight gain
- multiparity
- male fetus.
Maternal Hazards:
- Operative vaginal delivery
- perineal lacerations
- postpartum hemorrhage (uterine atony)
- emergency cesarean section
- pelvic floor injury.
Fetal Hazards:
- Shoulder dystocia
- birth injury
- asphyxia
Neonatal Hazards:
- Neonatal intensive care admission
- hypoglycemia
- Erb’s palsy.
Prevention:
No accurate ways of predicting or prevention are currently available.
Management:
Consider elective cesarean (if EFW >4,500 g in diabetic mother or >5,000 g in nondiabetic mother) or early induction, but this may result in increased cesarean delivery rate due to failure of induction.