Suspected big baby: a difficult clinical problem in obstetrics

Abstract

Based on the literature, labor should not be induced in nondiabetic pregnancies. The best policy is to await spontaneous birth or to induce labor after 42 weeks completion. A great number of cesarean sections have to be performed to avoid a single case of plexus brachialis paresis resulting from a difficult shoulder delivery. Cesarean section should not be considered in nondiabetic pregnancies unless the estimated fetal weight is above 5000 g. In pregnancies complicated by diabetes mellitus there are reasons for selective induction of labor if macrosomia is suspected and for cesarean section if the calculated birth weight is above 4000 g. Each department should have a strategy to handle such a situation because the problem with the difficult shoulder delivery cannot be completely avoided. Different procedures of managing difficult shoulder delivery are described.

Risk factors and obstetric complications associated with macrosomia

“…The four-fold increased risk of macrosomia in women delivering at N41 weeks gestation raises questions about the optimal management of patients at term with signs of macrosomia. Prior studies have not supported routine use of labor induction for the indication of macrosomia [16][17][18][19]. However, these studies have focused on limited outcomes, usually cesarean delivery and shoulder dystocia, and our findings indicate that there are other maternal morbidities to consider as well, such as fourth-degree lacerations.…”

Searching for the Definition of Macrosomia through an Outcome-Based Approach

“…A consensus has not yet been reached to define macrosomia. [14] Given that pregnant women are now older and heavier than before, this may contribute to bigger babies. [15], [16] An evidence-based definition of macrosomia is needed.…”

Fetal weight estimation in gestational diabetic pregnancies: comparison between conventional and three-dimensional fractional thigh volume methods using gestation-adjusted projection

“…There is no international consensus on the definition of macrosomia, but the most common definition is birth weight ≥ 4000 g, which occurs in 0.5–15% of all pregnancies. Macrosomia is associated with an increased risk for a number of perinatal complications including prolonged labor, shoulder dystocia with brachial palsy, facial nerve palsy, fractures of the clavicle and humerus, perinatal mortality and asphyxia.…”