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

Authors

  • San San Aye MMedSc MRCOG,

    Consultant Obstetrician and Gynaecologist, Corresponding author
    1. North Devon District Hospital, Raleigh Park, Barnstaple, Devon EX31 4JB, UK
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  • Veronica Miller MRCOG,

    Consultant Obstetrician and Gynaecologist
    1. Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Buckinghamshire HP21 8AL, UK
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  • Saloni Saxena MBBS,

    Senior House Officer in Obstetrics and Gynaecology
    1. University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK
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  • Dr Mohamad Farhan MBBS

    Senior House Officer in Obstetrics and Gynaecology
    1. Wycombe General Hospital, Queen Alexandra Road, High Wycombe, Bucks HP112TT, UK
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North Devon District Hospital, Raleigh Park, Barnstaple, Devon EX31 4JB, UK Email: sansanaye@hotmail.com

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.

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