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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.
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