Management of large‐for‐gestational‐age pregnancy in non‐diabetic women

Abstract

Key content Over the last two to three decades there has been a 15–25% increase in many countries in the number of women giving birth to large infants. Rates of shoulder dystocia and caesarean birth rise substantially at 4000 g and again at 4500 g. There is an increase in maternal and neonatal morbidity associated with fetal macrosomia. Serial measurement of fundal height adjusted for maternal physiological variables substantially improves antenatal detection. Sonographic assessment of fetal weight is frequently inaccurate. Induction of labour for suspected macrosomia in non‐diabetic women has not been shown to reduce the risk of caesarean section, instrumental delivery or perinatal morbidity. Learning objectives To identify the risks associated with fetal macrosomia and to be aware of the long‐term implications. To understand the limitations of predictive tools. To be able to take an informed approach to managing the macrosomic fetus. Ethical issues To what extent should the fear of medico‐legal action influence obstetricians' management of suspected fetal macrosomia? What advice should clinicians give women regarding modes of delivery? Please cite this article as: Aye SS, Miller V, Saxena S, Farhan M. Management of large‐for‐gestational‐age pregnancy in non‐diabetic women. The Obstetrician & Gynaecologist 2010;12:250–256.

Trends in the Prevalence of Live Macrosomic Newborns According to Gestational Age Strata, in Brazil, 2001–2010, and 2012–2014

“…1 However, there is little consensus on the cut-off weight that properly allows to classify newbornss as macrosomic. 2 Definitions based on percentiles are dependent on gestational age 3 and regional features. 4 These parameters increase the complexity to estimate the fetus' measures, and this limits their use in the obstetric practice.…”

Is the use of symphysis-fundal height measurement and ultrasound examination effective in detecting small or large fetuses?

“…SGA was defined as term birth weight 52,500 g and LGA 45,000 g according to local guidelines. However, we acknowledge that macrosomia is classified as 44,500 g (RCOG 2005; Aye et al 2010). We chose 45,000 g, since intervention is unlikely below this weight (Aye et al 2010).…”

“…Ultrasound examination (US) of the suspected LGA fetus in low risk women is no longer recommended due to lack of impact on fetal and maternal outcomes (NICE 2008) and obstetric guidelines should reflect this (Aye et al 2010).…”

Extremal linear quantile regression with Weibull-type tails

“…On the other hand, high birth weight also has serious adverse impacts on both maternal and child health. A baby born with an excessive birth weight may be at increased birth risks including injuries, respiratory distress syndrome, low blood sugar, jaundice, and long-term health risks such as type 2 diabetes, childhood obesity and metabolic syndrome; see for instance Aye et al (2010) and Mohammadbeigi et al (2013).…”