TOG Release: Management Of Large Babies In Non-diabetic Women

Main Category: Pregnancy / Obstetrics
Also Included In: Diabetes
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The management of pregnant women carrying large babies needs a holistic approach and regular assessment during labour is required says a new review published today in The Obstetrician & Gynaecologist (TOG).

The number of large newborns is on the increase. Over the last decade there has been a 15-25% increase in many countries in the number of women giving birth to large infants. This trend has been attributed to increases in maternal height, body mass, gestational weight gain and diabetes.

In addition, larger babies carry a greater risk of developing type 2 diabetes later in life, an increased risk of breast cancer premenopause and carry an increased risk of becoming overweight.

Macrosomia is a term used for newborns with a birthweight above a certain limit but there is no consensus on this limit. In this review the limit is more than 4500g.

Managing the delivery of large babies is challenging for clinicians and there is no consensus on this. Sonographic assessment of fetal weight is frequently inaccurate says the review. It states that serial measurements are needed of the fundal height adjusted for maternal variables such as age, weight, height, ethnicity and birthweight in previous pregnancies. A holistic approach is required taking into account all the different variables.

During labour regular assessment of progress is required, continuous electronic monitoring of the fetal heart rate should also be performed because of the increased oxygen requirement of the fetus. Rates of shoulder dystocia are also heightened the larger the baby. Prompt assessment and management of this are critical during labour.

The review also highlights that induction of labour for suspected macrosomia in non-diabetic women has not been shown to reduce the risk of caesarean section, instrumental delivery of perinatal morbidity.

Consultant Obstetrician and Gynaecologist San San Aye, from North Devon District Hospital and lead author of the review said:

"Excessive birth weight increases the risk of shoulder dystocia and caesarean birth substantially and this review highlights how best to manage the situation. It is important for clinicians to be aware of the risks associated with fetal macrosomia and be aware of the long-term implications.

"Women with a history of one macrosomic infant are more likely to have another and a change in maternal BMI during pregnancy can predict fetal macrosomia. Managing the situation holistically is important making sure all the mothers circumstances are taken into account."

TOG's Editor -in-Chief, Jason Waugh said:

"This review gives us an informed approach to managing the macrosomic fetus and with the growing rate of larger babies it is vital regular and thorough assessments are carried out on these babies throughout pregnancy and labour."

Reference

Aye SS, MillerV, Saxena S, Farhan M. Management of large-for-gestational-age pregnancy in non-diabetic women. The Obstetrician & Gynaecologist 2010;12:250-256.

Source:
The Obstetrician & Gynaecologist

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