LGA

Question 1

Definition LGA

Answer 1

EFW > 90th centile
or
Birth weight > 4kg or >4.5kg

Question 2

Risks of LGA

Answer 2

To baby:

• Stillbirth, particularly if EFW>5kg
• Congenital abnormalities
• Neonatal: Hypoglycaemia, admission to SCBU/NICU, respiratory problems, polycythaemia
• Later in life- obesity, metabolic syndrome, cardiac remodeling, impaired glucose tolerance

Labour:

• labour dystocia
• EMCS for obstructed labour
• Instrumental delivery
• Shoulder dystocia
• Perineal trauma (including OASIS)
• PPH

Question 3

Results of 2016 cochrane review for IOL near or at term for macrosomia.

Answer 3

Review of 4 trials found-

• Intervention = IOL 37-40 wks in babies with suspected macrosomia
• IOL group: reduction in incidence of shoulder dystocia, birth weight and #clavicle but 1 study found increase in 3/4th degree perineal tears.
• No difference in CS rate, brachial plexus injury rate or instrumental delivery rate.

Question 4

Risk factors for LGA

Answer 4

• Diabetes – pre-existing or gestational
• Maternal obesity
• Maternal weight gain during pregnancy
• Previous macrosomic baby
• Male fetus
• Multiparity
• Prolonged gestation
• Ethnicity – Hispanic and white babies are bigger
• Congenital disorders (genetic syndromes) – eg Beckwith-Wiedemann syndrome, Simpson-Golabi-Behmel syndrome, Sotos syndrome, Weaver syndrome, and Berardinelli lipodystrophia.

Question 5

What is the definition of LGA?

Answer 5

BW > 90th centile

Question 6

What is the definition of macrosomia?

Answer 6

BW >4000g

Excessive intrauterine growth beyond a specific threshold, regardless of gestational age

Question 7

What are the risk factors for LGA?

Answer 7

• Ethnicity: Samoan, white
• Genetic syndrome
• Maternal diabetes, especially poorly controlled
• Maternal pre-preg weight
• Excessive GWG
• Multiparity
• AMA
• Post-dates
• Male
• Previous LGA
• Maternal BW > 4000g

Question 8

What are the maternal complications of LGA?

Answer 8

Prolonged labour
Operative vaginal delivery
Caesarean section
Perineal trauma
PPH
Uterine rupture

Question 9

What are the fetal complications of LGA?

Answer 9

Shoulder dystocia leading to birth trauma, brachial plexus injury

Stillbirth. Fetuses >5000g particularly high risk

Question 10

What are the neonatal complications of LGA?

Answer 10

Hypoglycaemia
Respiratory problems
Polycythemia
Minor congenital anomalies
NICU admission (can be prolonged)

Question 11

What are the implications of LGA on childhood and beyond?

Answer 11

Obesity
Impaired glucose tolerance
Metabolic syndrome
Cardiac remodelling