Materiały źródłowe

• #1 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  Macrosomia refers to excessive fetal growth, typically defined by an absolute birth weight rather than gestational age. Historically, birth weights of 4,000 g or 4,500 g have been used to classify macrosomia, though no universal definition has been accepted. Maternal and neonatal risks increase significantly with higher birth weights. Prenatal prediction of macrosomia is challenging. Ultrasonography, the most common tool for estimating fetal weight, has limited accuracy, with errors increasing as fetal weight rises. Clinical assessment methods are similarly unreliable, as factors like maternal obesity can lead to overestimations or inconsistent results. […] Management of suspected macrosomia involves careful consideration of delivery options. While cesarean delivery may reduce certain risks, it does not entirely prevent complications. Scheduled cesarean sections are often recommended for suspected birth weights above 5,000 g in women without diabetes and 4,500 g in women with diabetes. However, this approach remains controversial due to the lack of conclusive evidence from randomized trials. For vaginal deliveries, individualized counseling is essential, taking into account maternal and fetal health, prior obstetric history, and the suspected degree of macrosomia.

• #2 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia

  Fetal macrosomia refers to growth beyond a specific threshold, regardless of gestational age. In high income countries, the most commonly used threshold is weight above 4500 g (9 lb 15 oz), but weight above 4000 g (8 lb 13 oz) is also commonly used. A grading system has been suggested: grade 1 for infants 4000 to 4499 g, grade 2 for 4500 to 4999 g, and grade 3 for over 5000 g. This system may be useful at term for decision-making regarding forceps- or vacuum-assisted vaginal birth. […] Macrosomia is associated with an increased risk of several complications, particularly maternal and/or fetal trauma during birth and neonatal hypoglycemia and respiratory problems. Long-term adverse effects in these offspring include increased risks for obesity and insulin resistance. […] This topic will review the definition, prevalence, significance, risk factors, etiology, and diagnosis of macrosomia.

• #3 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia

  Limitations and controversies — Absolute weight thresholds are not useful for identifying the preterm macrosomic fetus since they are not based upon population statistics, where normal weight is typically defined as between the 10th and 90th percentile for gestational age. Using a statistical approach, any fetus/newborn weighing >90th percentile for gestational age is considered large for gestational age. […] Generating local tables, when possible, should be considered if the population involved is constitutionally more uniform but different from published tables. Using contemporary country-specific percentile tables is advisable when interpreting estimated fetal and newborn weight, particularly in low and middle income countries. […] Most relatively recent research has shown that White mothers tend to have the largest fetuses, followed by Hispanic mothers, then Black mothers. This may involve both biologic and social determinants of health.

• #4 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia/print

  Fetal macrosomia refers to growth beyond a specific threshold, regardless of gestational age. A fetus larger than 4000 to 4500 grams (or 9 to 10 pounds) is considered macrosomic. Macrosomia is associated with an increased risk of several complications, particularly maternal and/or fetal trauma during birth and neonatal hypoglycemia and respiratory problems. This topic will review the definition, prevalence, significance, risk factors, etiology, and diagnosis of macrosomia. […] Limitations and controversies — Absolute weight thresholds are not useful for identifying the preterm macrosomic fetus since they are not based upon population statistics, where normal weight is typically defined as between the 10th and 90th percentile for gestational age (assuming a normal population distribution). […] Using contemporary country-specific percentile tables is advisable when interpreting estimated fetal and newborn weight, particularly in low and middle income countries.

• #5 Fetal macrosomia

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20372561

  Fetal macrosomia can’t be diagnosed until after the baby is born and weighed. […] However, if you have risk factors for fetal macrosomia, your health care provider will likely use tests to monitor your baby’s health and development while you’re pregnant, such as: […] Ultrasound. Toward the end of your third trimester, your health care provider or another member of your health care team might do an ultrasound to take measurements of parts of your baby’s body, such as the head, abdomen and femur. Your health care provider will then plug these measurements into a formula to estimate your baby’s weight. […] However, the accuracy of ultrasound for predicting fetal macrosomia has been unreliable. […] If your health care provider suspects fetal macrosomia, he or she might perform antenatal testing, such as a nonstress test or a fetal biophysical profile, to monitor your baby’s well-being.

• #6 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The Committee on Practice BulletinsObstetrics of the American College of Obstetricians and Gynecologists (ACOG) has issued new clinical management guidelines on fetal macrosomia. ACOG Practice Bulletin No. 22, which replaces Technical Bulletin No. 159 issued in September 1991, appears in the November 2000 issue of Obstetrics and Gynecology. These guidelines discuss risk factors and complications, and suggest clinical management for the pregnancy with suspected fetal macrosomia. […] Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise. […] According to the ACOG committee, the risk factors (excluding preexisting diabetes mellitus) for fetal macrosomia, in decreasing order of importance, are as follows: a history of macrosomia, maternal prepregnancy weight, weight gain during pregnancy, multiparity, male fetus, gestational age more than 40 weeks, ethnicity, maternal birth weight, maternal height, maternal age younger than 17 years and a positive 50-g glucose screen with a negative result on the three-hour glucose tolerance test.

• #7 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  ACOG recommends targeted evaluation for type 2 diabetes early in pregnancy with a 75-g or 50-g oral glucose tolerance test at the initial prenatal visit in patients who have a BMI of 30 kg/m2 or more and 1 of the following risk factors: History of GDM, Hemoglobin A1C 5.7% on previous testing, Immediate family member with diabetes, High-risk race (eg, African American, Latin American, Native American, Asian American, Pacific Islander), Cardiovascular disease history, Hypertension, High-density lipoprotein (HDL) cholesterol level 35 mg/dL or a triglyceride level 250 mg/dL, Polycystic ovary syndrome, Physical inactivity. […] According to ACOG, weighting the newborn after delivery is the most accurate way to diagnose macrosomia, and no singular modality such as the Leopold maneuver, fundal height measurement, or an ultrasound scan can effectively diagnose macrosomia. On the other hand, a combination of these factors should warrant a very high suspicion index.

• #8 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  The three major strategies used to predict macrosomia are clinical risk factors, clinician estimation by Leopold’s maneuvers and ultrasonography. Each method has substantial limitations. […] A number of risk factors for fetal macrosomia have been recognized. The strongest risk factor is maternal diabetes, which results in a twofold increase in the incidence of macrosomia. […] The volume of amniotic fluid, the size and configuration of the uterus and maternal body habitus complicate estimation of the size of the fetus by palpation through the abdominal wall. […] Ultrasonography has been proposed as a more accurate method of estimation of fetal weight. Unfortunately, the typical mean error ranges from 300 to 550 g (11.6 to 19.4 oz). […] The delivery of a macrosomic infant has potentially serious consequences for the infant and the mother. The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle.

• #9 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The Committee on Practice BulletinsObstetrics of the American College of Obstetricians and Gynecologists (ACOG) has issued new clinical management guidelines on fetal macrosomia. ACOG Practice Bulletin No. 22, which replaces Technical Bulletin No. 159 issued in September 1991, appears in the November 2000 issue of Obstetrics and Gynecology. These guidelines discuss risk factors and complications, and suggest clinical management for the pregnancy with suspected fetal macrosomia. […] Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise. […] According to the ACOG committee, the risk factors (excluding preexisting diabetes mellitus) for fetal macrosomia, in decreasing order of importance, are as follows: a history of macrosomia, maternal prepregnancy weight, weight gain during pregnancy, multiparity, male fetus, gestational age more than 40 weeks, ethnicity, maternal birth weight, maternal height, maternal age younger than 17 years and a positive 50-g glucose screen with a negative result on the three-hour glucose tolerance test.

• #10 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The Committee on Practice BulletinsObstetrics of the American College of Obstetricians and Gynecologists (ACOG) has issued new clinical management guidelines on fetal macrosomia. ACOG Practice Bulletin No. 22, which replaces Technical Bulletin No. 159 issued in September 1991, appears in the November 2000 issue of Obstetrics and Gynecology. These guidelines discuss risk factors and complications, and suggest clinical management for the pregnancy with suspected fetal macrosomia. […] Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise. […] According to the ACOG committee, the risk factors (excluding preexisting diabetes mellitus) for fetal macrosomia, in decreasing order of importance, are as follows: a history of macrosomia, maternal prepregnancy weight, weight gain during pregnancy, multiparity, male fetus, gestational age more than 40 weeks, ethnicity, maternal birth weight, maternal height, maternal age younger than 17 years and a positive 50-g glucose screen with a negative result on the three-hour glucose tolerance test.

• #11 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  The three major strategies used to predict macrosomia are clinical risk factors, clinician estimation by Leopold’s maneuvers and ultrasonography. Each method has substantial limitations. […] A number of risk factors for fetal macrosomia have been recognized. The strongest risk factor is maternal diabetes, which results in a twofold increase in the incidence of macrosomia. […] The volume of amniotic fluid, the size and configuration of the uterus and maternal body habitus complicate estimation of the size of the fetus by palpation through the abdominal wall. […] Ultrasonography has been proposed as a more accurate method of estimation of fetal weight. Unfortunately, the typical mean error ranges from 300 to 550 g (11.6 to 19.4 oz). […] The delivery of a macrosomic infant has potentially serious consequences for the infant and the mother. The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle.

• #12 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  ACOG recommends targeted evaluation for type 2 diabetes early in pregnancy with a 75-g or 50-g oral glucose tolerance test at the initial prenatal visit in patients who have a BMI of 30 kg/m2 or more and 1 of the following risk factors: History of GDM, Hemoglobin A1C 5.7% on previous testing, Immediate family member with diabetes, High-risk race (eg, African American, Latin American, Native American, Asian American, Pacific Islander), Cardiovascular disease history, Hypertension, High-density lipoprotein (HDL) cholesterol level 35 mg/dL or a triglyceride level 250 mg/dL, Polycystic ovary syndrome, Physical inactivity. […] According to ACOG, weighting the newborn after delivery is the most accurate way to diagnose macrosomia, and no singular modality such as the Leopold maneuver, fundal height measurement, or an ultrasound scan can effectively diagnose macrosomia. On the other hand, a combination of these factors should warrant a very high suspicion index.

• #13 Macrosomia – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557577/

  Macrosomia refers to excessive fetal growth, typically defined by an absolute birth weight rather than gestational age. Historically, birth weights of 4,000 g or 4,500 g have been used to classify macrosomia, though no universal definition has been accepted. Maternal and neonatal risks increase significantly with higher birth weights. Prenatal prediction of macrosomia is challenging. Ultrasonography, the most common tool for estimating fetal weight, has limited accuracy, with errors increasing as fetal weight rises. Clinical assessment methods are similarly unreliable, as factors like maternal obesity can lead to overestimations or inconsistent results. […] Management of suspected macrosomia involves careful consideration of delivery options. While cesarean delivery may reduce certain risks, it does not entirely prevent complications. Scheduled cesarean sections are often recommended for suspected birth weights above 5,000 g in women without diabetes and 4,500 g in women with diabetes. However, this approach remains controversial due to the lack of conclusive evidence from randomized trials. For vaginal deliveries, individualized counseling is essential, taking into account maternal and fetal health, prior obstetric history, and the suspected degree of macrosomia.

• #14 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold’s maneuvers). […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #15 ACOG Practice Bulletin 173: Fetal Macrosomia – OPQIC

  https://opqic.org/acog-practice-bulletin-173-fetal-macrosomia/

  Suspected fetal macrosomia is encountered commonly in obstetric practice. The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Level A). Suspected fetal macrosomia is not an indication for induction of labor because induction does not improve maternal or fetal outcomes (Level B). With an estimated fetal weight of greater than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery (Level B). Barring unusual circumstances, cesarean delivery should be performed for midpelvic arrest of the fetus with suspected macrosomia (Level B). As with clinical estimates of fetal weight, the true value of ultrasonography in the management of expected fetal macrosomia may be its ability to rule out the diagnosis, which may help to avoid maternal morbidity (Level B).

• #16 Large for gestational age – Wikipedia

  https://en.wikipedia.org/wiki/Large_for_gestational_age

  Diagnosing fetal macrosomia cannot be performed until after birth, as evaluating a baby’s weight in the womb may be inaccurate. While ultrasound has been the primary method for diagnosing LGA, this form of fetal weight assessment remains imprecise, as the fetus is a highly variable structure in regards to density and weight no matter the gestational age. Ultrasonography involves an algorithm that incorporates biometric measurements of the fetus, such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), to calculate the estimated fetal weight (EFW). Variability of fetal weight estimations has been linked to differences due to sensitivity and specificity of ultrasound algorithms as well as to the individual performing the ultrasound examination.

• #17 Large for gestational age – Wikipedia

  https://en.wikipedia.org/wiki/Large_for_gestational_age

  Diagnosing fetal macrosomia cannot be performed until after birth, as evaluating a baby’s weight in the womb may be inaccurate. While ultrasound has been the primary method for diagnosing LGA, this form of fetal weight assessment remains imprecise, as the fetus is a highly variable structure in regards to density and weight no matter the gestational age. Ultrasonography involves an algorithm that incorporates biometric measurements of the fetus, such as biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), and femur length (FL), to calculate the estimated fetal weight (EFW). Variability of fetal weight estimations has been linked to differences due to sensitivity and specificity of ultrasound algorithms as well as to the individual performing the ultrasound examination.

• #18 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  It has been established that at higher fetal weights there is reduced accuracy of ultrasound in estimating fetal weight, most notable for birth weights over 4500g, thereby providing a greater challenge in care decisions and prediction of birth weight in suspected macrosomic infants. […] Most ultrasound machines have one or more estimated fetal weight equations in the software. Most of these equations are associated with significant errors. The Hadlock formula is commonly used, and it has a mean absolute percent error of 13% for birth weight of 4500g compared with 8% for non-macrosomic newborns. No single formula has been proven to be superior to another for detection of macrosomia of more than 4500 g. […] More recent studies have confirmed that appropriately performed abdominal circumference measurements by ultrasonography in the third trimester is the best way of predicting neonatal weight. Without doubt, the usefulness of this technique depends on the quality of image obtained in late third trimester and the cut off used to define the at-risk neonate. Studies using different cut-offs have come with a variety of positive and negative predictive values as well as sensitivities and specificities.

• #19 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  A glucose tolerance test at 24-28 weeks of gestation screens for gestational diabetes, a known risk factor for macrosomia. Identification and treatment of gestational diabetes has been shown in randomized controlled trials to decrease fetal birth weight, thereby reducing risk of macrosomia. […] Neonatal evaluation for hypoglycemia, polycythemia, hyperbilirubinemia, and electrolyte abnormalities is indicated in all macrosomic newborns because maternal hyperglycemia is the most common cause and sometimes this diagnosis is not made in the mother prior to delivery of her child. […] Ultrasound measurements to obtain estimated fetal weights are indicated when clinical assessments indicate a uterine size greater than that expected for the gestational age. An examination within 1-2 weeks of delivery showing an abdominal circumference of 35 cm or larger should alert the clinician to anticipate a fetus with a birthweight of 4000 g or more. The definitive diagnosis can only be made after delivery of the neonate.

• #20 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  It has been established that at higher fetal weights there is reduced accuracy of ultrasound in estimating fetal weight, most notable for birth weights over 4500g, thereby providing a greater challenge in care decisions and prediction of birth weight in suspected macrosomic infants. […] Most ultrasound machines have one or more estimated fetal weight equations in the software. Most of these equations are associated with significant errors. The Hadlock formula is commonly used, and it has a mean absolute percent error of 13% for birth weight of 4500g compared with 8% for non-macrosomic newborns. No single formula has been proven to be superior to another for detection of macrosomia of more than 4500 g. […] More recent studies have confirmed that appropriately performed abdominal circumference measurements by ultrasonography in the third trimester is the best way of predicting neonatal weight. Without doubt, the usefulness of this technique depends on the quality of image obtained in late third trimester and the cut off used to define the at-risk neonate. Studies using different cut-offs have come with a variety of positive and negative predictive values as well as sensitivities and specificities.

• #21 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  It has been established that at higher fetal weights there is reduced accuracy of ultrasound in estimating fetal weight, most notable for birth weights over 4500g, thereby providing a greater challenge in care decisions and prediction of birth weight in suspected macrosomic infants. […] Most ultrasound machines have one or more estimated fetal weight equations in the software. Most of these equations are associated with significant errors. The Hadlock formula is commonly used, and it has a mean absolute percent error of 13% for birth weight of 4500g compared with 8% for non-macrosomic newborns. No single formula has been proven to be superior to another for detection of macrosomia of more than 4500 g. […] More recent studies have confirmed that appropriately performed abdominal circumference measurements by ultrasonography in the third trimester is the best way of predicting neonatal weight. Without doubt, the usefulness of this technique depends on the quality of image obtained in late third trimester and the cut off used to define the at-risk neonate. Studies using different cut-offs have come with a variety of positive and negative predictive values as well as sensitivities and specificities.

• #22 ACOG Practice Bulletin 173: Fetal Macrosomia – OPQIC

  https://opqic.org/acog-practice-bulletin-173-fetal-macrosomia/

  Suspected fetal macrosomia is encountered commonly in obstetric practice. The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Level A). Suspected fetal macrosomia is not an indication for induction of labor because induction does not improve maternal or fetal outcomes (Level B). With an estimated fetal weight of greater than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery (Level B). Barring unusual circumstances, cesarean delivery should be performed for midpelvic arrest of the fetus with suspected macrosomia (Level B). As with clinical estimates of fetal weight, the true value of ultrasonography in the management of expected fetal macrosomia may be its ability to rule out the diagnosis, which may help to avoid maternal morbidity (Level B).

• #23 Measurement of fetal subcutaneous fat in the diagnosis of fetal macrosomia in pregnancies with diabetes mellitus | ESPE2023 | 61st Annual ESPE (ESPE 2023) | ESPE Abstracts

  https://abstracts.eurospe.org/hrp/0097/hrp0097p1-282

  Measurement of fetal subcutaneous fat in the diagnosis of fetal macrosomia in pregnancies with diabetes mellitus […] The aim of study was to assess the possibility of diagnosing disproportionate development of a newborn according to antenatal measurements of fetal subcutaneous fat. […] Fetuses from mothers with diabetes mellitus are characterized by a more significant accumulation of subcutaneous fat in the upper half of the body, which correlates with the WLR by gestational age and sex: fetal sub-scapular fat mass and WLR rs=0.76, P0.001, fetal abdominal fat mass and WLR rs=0.85, P0.001, fetal mid-thigh fat mass and WLR rs=0.77, P0.001. […] The calculated cut-off values of fetal subcutaneous fat (fetal sub-scapular fat mass 5.8 mm or more (AUC 0.93 (0.86-0.99), P0.001), fetal abdominal fat 5.8 mm or more (AUC 0.97 (0.93-1.00), P0.001), fetal mid-thigh fat mass 4.4 mm or more (AUC 0.94 (0.87-0.99), P0.001) with high specificity (95.7%, 91.3% and 87.0%) and sensitivity (73.3%, 93.3% and 93.3%) allow antenatal diagnosis of disproportionate fetal development in women with diabetes mellitus. […] The study of fetal subcutaneous fat is an important step in the diagnosis of fetal macrosomia.

• #24 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  The three major strategies used to predict macrosomia are clinical risk factors, clinician estimation by Leopold’s maneuvers and ultrasonography. Each method has substantial limitations. […] A number of risk factors for fetal macrosomia have been recognized. The strongest risk factor is maternal diabetes, which results in a twofold increase in the incidence of macrosomia. […] The volume of amniotic fluid, the size and configuration of the uterus and maternal body habitus complicate estimation of the size of the fetus by palpation through the abdominal wall. […] Ultrasonography has been proposed as a more accurate method of estimation of fetal weight. Unfortunately, the typical mean error ranges from 300 to 550 g (11.6 to 19.4 oz). […] The delivery of a macrosomic infant has potentially serious consequences for the infant and the mother. The most feared result of macrosomia is shoulder dystocia, and up to one fourth of infants with shoulder dystocia experience brachial plexus or facial nerve injuries, or fractures of the humerus or clavicle.

• #25 Fetal Macrosomia

  https://mobile.fpnotebook.com/OB/Fetus/FtlMcrsm.htm

  Fetal weight 4500 grams (ranges from 4000-5000 grams) […] Birth weight above 90th percentile […] Clinician’s fetal weight estimate (Leopold’s Maneuvers) […] More accurate than Obstetric Ultrasound estimate […] Obstetric Ultrasound […] Correlates 88% with diagnosis of macrosomia […] ACOG recommends considering cesarean delivery for fetal weight 5000 g (11 lb) […] ACOG recommends considering cesarean delivery for Gestational Diabetes AND weight 4500 g (9 lb 15 oz) […] Tight glycemic control […] Decreased Fetal Macrosomia […] Indications per ACOG […] Estimated fetal weight 4500 grams.

• #26 Fetal Macrosomia: What Is It, Causes & Complications

  https://my.clevelandclinic.org/health/diseases/17795-fetal-macrosomia

  Fetal macrosomia is a condition in which the fetus is larger than average (between 4,000 grams [8 pounds, 13 ounces] and 4,500 grams [9 pounds, 15 ounces]). […] Fetal macrosomia is a condition where your baby’s weight is in the top 10% of the stage of pregnancy you’re in. […] Your healthcare provider may suspect your baby has macrosomia if you: Have a large fundal height (a measurement of fetal growth). Have gained a lot of weight during pregnancy. Have diabetes, or were diagnosed with gestational diabetes. You’ve previously delivered a large baby. You’ve gone past your due date. You were a big baby yourself. […] Your healthcare provider may order an ultrasound to check the fetal weight and amount of amniotic fluid. […] Ultrasound can only estimate a fetus’s weight within about 10%.

• #27 Fetal Macrosomia: What Is It, Causes & Complications

  https://my.clevelandclinic.org/health/diseases/17795-fetal-macrosomia

  Fetal macrosomia is a condition in which the fetus is larger than average (between 4,000 grams [8 pounds, 13 ounces] and 4,500 grams [9 pounds, 15 ounces]). […] Fetal macrosomia is a condition where your baby’s weight is in the top 10% of the stage of pregnancy you’re in. […] Your healthcare provider may suspect your baby has macrosomia if you: Have a large fundal height (a measurement of fetal growth). Have gained a lot of weight during pregnancy. Have diabetes, or were diagnosed with gestational diabetes. You’ve previously delivered a large baby. You’ve gone past your due date. You were a big baby yourself. […] Your healthcare provider may order an ultrasound to check the fetal weight and amount of amniotic fluid. […] Ultrasound can only estimate a fetus’s weight within about 10%.

• #28 Fetal Macrosomia(Large Baby)

  https://www.birthinjuryhelpcenter.org/birth-injuries/prenatal-problems/fetal-macrosomia/

  Amniotic fluid is the fluid that surrounds and protects the fetus while it grows inside the uterus during pregnancy. […] For this reason, consistently high levels of amniotic fluid are a primary indicator of fetal macrosomia. […] Fundal height is basically the distance (measured in centimeters) between the uterus and the very top of the mothers pelvic bone. […] If fundal height is consistently shorter than normal (i.e., the distance between the pelvis and uterus is smaller than expected) this can be a key sign that the baby is overly large. […] The primary risk posed by fetal macrosomia is that the baby is very likely to become stuck or suffer physical trauma in a normal vaginal delivery. […] When fetal macrosomia is timely diagnosed in advance, this problem can easily be avoided simply by delivering the baby via a scheduled C-section.

• #29 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia

  […] […] DIAGNOSIS […] Ultrasound examination, diagnostic performance of ultrasound, formulas for estimating fetal weight, predictive value of abdominal circumference, and adjunctive sonographic measurements are all methods used in the diagnosis of fetal macrosomia. […] NONSONOGRAPHIC DIAGNOSTIC METHODS include maternal estimation, physical examination, magnetic resonance imaging, and novel biomarkers. […] DIAGNOSIS IN SPECIAL SITUATIONS includes patients with diabetes, breech presentation, and multiple gestation.

• #30 Fetal macrosomia – UpToDate

  https://www.uptodate.com/contents/fetal-macrosomia

  […] […] DIAGNOSIS […] Ultrasound examination, diagnostic performance of ultrasound, formulas for estimating fetal weight, predictive value of abdominal circumference, and adjunctive sonographic measurements are all methods used in the diagnosis of fetal macrosomia. […] NONSONOGRAPHIC DIAGNOSTIC METHODS include maternal estimation, physical examination, magnetic resonance imaging, and novel biomarkers. […] DIAGNOSIS IN SPECIAL SITUATIONS includes patients with diabetes, breech presentation, and multiple gestation.

• #31 Fetal macrosomia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/symptoms-causes/syc-20372579

  The term „fetal macrosomia” is used to describe a newborn who’s much larger than average. […] A baby who is diagnosed as having fetal macrosomia weighs more than 8 pounds, 13 ounces (4,000 grams), regardless of his or her gestational age. About 9% of babies worldwide weigh more than 8 pounds, 13 ounces. […] Fetal macrosomia can be difficult to detect and diagnose during pregnancy. Signs and symptoms include: […] A larger than expected fundal height could be a sign of fetal macrosomia. […] Having too much amniotic fluid the fluid that surrounds and protects a baby during pregnancy might be a sign that your baby is larger than average. […] Fetal macrosomia is more likely to be a result of maternal diabetes, obesity or weight gain during pregnancy than other causes. […] If a rare medical condition is suspected, your health care provider might recommend prenatal diagnostic tests and perhaps a visit with a genetic counselor, depending on the test results.

• #32 Fetal Macrosomia(Large Baby)

  https://www.birthinjuryhelpcenter.org/birth-injuries/prenatal-problems/fetal-macrosomia/

  Amniotic fluid is the fluid that surrounds and protects the fetus while it grows inside the uterus during pregnancy. […] For this reason, consistently high levels of amniotic fluid are a primary indicator of fetal macrosomia. […] Fundal height is basically the distance (measured in centimeters) between the uterus and the very top of the mothers pelvic bone. […] If fundal height is consistently shorter than normal (i.e., the distance between the pelvis and uterus is smaller than expected) this can be a key sign that the baby is overly large. […] The primary risk posed by fetal macrosomia is that the baby is very likely to become stuck or suffer physical trauma in a normal vaginal delivery. […] When fetal macrosomia is timely diagnosed in advance, this problem can easily be avoided simply by delivering the baby via a scheduled C-section.

• #33 Macrosomia | Obgyn Key

  https://obgynkey.com/macrosomia-2/

  Fetal macrosomia is defined as birth weight 4000 g and is associated with several maternal and fetal complications such as maternal birth canal trauma, shoulder dystocia, and perinatal asphyxia. […] Early identification of risk factors could allow preventive measures to be taken to avoid adverse perinatal outcomes. […] Prenatal diagnosis is based on two-dimensional ultrasound formulae, but accuracy is low, particularly at advanced gestation. […] Three-dimensional ultrasound could be an alternative to soft tissue monitoring, allowing better prediction of birth weight than two-dimensional ultrasound. […] Prediction of fetal macrosomia may be performed using clinical and ultrasonographic evaluation. […] Clinical evaluation is based on maternal fundal height assessment. […] Ultrasound estimation of fetal weight (EFW) may not be accurate, resulting in an increased rate of false positive tests.

• #34 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  A study by Badr et al used models based on magnetic resonance imaging (MRI) and ultrasonography in primigravid patients to predict the gestational age at which the birthweight is expected to exceed 4000 g. The model based on MRI performed better than the ultrasound-based model in identifying patients at highest risk for delivery of an infant with macrosomia.

• #35 Ultrasound examination in the diagnosis of fetal macrosomia – Lebedeva – Kazan medical journal

  https://kazanmedjournal.ru/kazanmedj/article/view/10301/en_US

  Ultrasound examination in obstetrics is a method of screening of pregnant women including identification of fetal macrosomia. Diagnosis of macrosomia is extremely important, along with other indications the conclusion about the presence of a large fetus may affect the tactics of giving birth. […] In women with GD fetal macrosomia is the main complication, which often together with others serves as an indication for a planned cesarean section in order to reduce potentially possible perinatal complications, as macrosomia of diabetic origin is characterized by disproportional distribution of subcutaneous adipose tissue in the fetus with predominant localization in the upper half of the trunk, which increases the probability of dystocia of the shoulders and damage to the brachial plexus. […] At the moment, to determine the estimated weight of the fetus, the formulas created more than 30 years ago are used and their accuracy is not always high. The difficulty is caused by the lack of data on the diagnostic accuracy of macrosomal markers. A search is being made for additional parameters capable of increasing the diagnostic value of ultrasound method for determining the estimated weight of the fetus.

• #36 Ultrasound examination in the diagnosis of fetal macrosomia – Lebedeva – Kazan medical journal

  https://kazanmedjournal.ru/kazanmedj/article/view/10301/en_US

  Ultrasound examination in obstetrics is a method of screening of pregnant women including identification of fetal macrosomia. Diagnosis of macrosomia is extremely important, along with other indications the conclusion about the presence of a large fetus may affect the tactics of giving birth. […] In women with GD fetal macrosomia is the main complication, which often together with others serves as an indication for a planned cesarean section in order to reduce potentially possible perinatal complications, as macrosomia of diabetic origin is characterized by disproportional distribution of subcutaneous adipose tissue in the fetus with predominant localization in the upper half of the trunk, which increases the probability of dystocia of the shoulders and damage to the brachial plexus. […] At the moment, to determine the estimated weight of the fetus, the formulas created more than 30 years ago are used and their accuracy is not always high. The difficulty is caused by the lack of data on the diagnostic accuracy of macrosomal markers. A search is being made for additional parameters capable of increasing the diagnostic value of ultrasound method for determining the estimated weight of the fetus.

• #37 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  A glucose tolerance test at 24-28 weeks of gestation screens for gestational diabetes, a known risk factor for macrosomia. Identification and treatment of gestational diabetes has been shown in randomized controlled trials to decrease fetal birth weight, thereby reducing risk of macrosomia. […] Neonatal evaluation for hypoglycemia, polycythemia, hyperbilirubinemia, and electrolyte abnormalities is indicated in all macrosomic newborns because maternal hyperglycemia is the most common cause and sometimes this diagnosis is not made in the mother prior to delivery of her child. […] Ultrasound measurements to obtain estimated fetal weights are indicated when clinical assessments indicate a uterine size greater than that expected for the gestational age. An examination within 1-2 weeks of delivery showing an abdominal circumference of 35 cm or larger should alert the clinician to anticipate a fetus with a birthweight of 4000 g or more. The definitive diagnosis can only be made after delivery of the neonate.

• #38 Ultrasonic predictors of macrosomia in gestational diabetes mellitus | Lysenko | Diabetes mellitus

  https://www.dia-endojournals.ru/jour/article/view/10109/en_US?locale=en_US

  The basis of early ultrasound (US) diagnosis of diabetic fetopathy (DF) in pregnant with gestational diabetes mellitus (GDM) is the forehanded detection of macrosomia, especially its asymmetric forms. […] In pregnant with GDM on a diet therapy, the detection of macrosomia may be an indication for starting the insulin therapy. […] The most effective predictive fetometric indicators for the diagnosis of fetal macrosomia are the dimensions of fetal abdomen and fetal weight 90 percentile for gestational age. […] A specific sign of DF in pregnant with GDM is the asymmetric macrosomia.

• #39 Ultrasound examination in the diagnosis of fetal macrosomia – Lebedeva – Kazan medical journal

  https://kazanmedjournal.ru/kazanmedj/article/view/10301/en_US

  Ultrasound examination in obstetrics is a method of screening of pregnant women including identification of fetal macrosomia. Diagnosis of macrosomia is extremely important, along with other indications the conclusion about the presence of a large fetus may affect the tactics of giving birth. […] In women with GD fetal macrosomia is the main complication, which often together with others serves as an indication for a planned cesarean section in order to reduce potentially possible perinatal complications, as macrosomia of diabetic origin is characterized by disproportional distribution of subcutaneous adipose tissue in the fetus with predominant localization in the upper half of the trunk, which increases the probability of dystocia of the shoulders and damage to the brachial plexus. […] At the moment, to determine the estimated weight of the fetus, the formulas created more than 30 years ago are used and their accuracy is not always high. The difficulty is caused by the lack of data on the diagnostic accuracy of macrosomal markers. A search is being made for additional parameters capable of increasing the diagnostic value of ultrasound method for determining the estimated weight of the fetus.

• #40 Measurement of fetal subcutaneous fat in the diagnosis of fetal macrosomia in pregnancies with diabetes mellitus | ESPE2023 | 61st Annual ESPE (ESPE 2023) | ESPE Abstracts

  https://abstracts.eurospe.org/hrp/0097/hrp0097p1-282

  Measurement of fetal subcutaneous fat in the diagnosis of fetal macrosomia in pregnancies with diabetes mellitus […] The aim of study was to assess the possibility of diagnosing disproportionate development of a newborn according to antenatal measurements of fetal subcutaneous fat. […] Fetuses from mothers with diabetes mellitus are characterized by a more significant accumulation of subcutaneous fat in the upper half of the body, which correlates with the WLR by gestational age and sex: fetal sub-scapular fat mass and WLR rs=0.76, P0.001, fetal abdominal fat mass and WLR rs=0.85, P0.001, fetal mid-thigh fat mass and WLR rs=0.77, P0.001. […] The calculated cut-off values of fetal subcutaneous fat (fetal sub-scapular fat mass 5.8 mm or more (AUC 0.93 (0.86-0.99), P0.001), fetal abdominal fat 5.8 mm or more (AUC 0.97 (0.93-1.00), P0.001), fetal mid-thigh fat mass 4.4 mm or more (AUC 0.94 (0.87-0.99), P0.001) with high specificity (95.7%, 91.3% and 87.0%) and sensitivity (73.3%, 93.3% and 93.3%) allow antenatal diagnosis of disproportionate fetal development in women with diabetes mellitus. […] The study of fetal subcutaneous fat is an important step in the diagnosis of fetal macrosomia.

• #41 Diagnosis and Prediction of Large-for-Gestational-Age Fetus Using the Stacked Generalization Method

  https://www.mdpi.com/2076-3417/9/20/4317

  An accurate and efficient Large-for-Gestational-Age (LGA) classification system is developed to classify a fetus as LGA or non-LGA, which has the potential to assist paediatricians and experts in establishing a state-of-the-art LGA prognosis process. […] The performance of the proposed scheme is validated by using LGA dataset collected from the National Pre-Pregnancy and Examination Program of China (2010–2013). […] The proposed GridSearch-based RFECV+IG feature selection scheme with stacking using SVM (linear kernel) best suits the said classification process followed by SVM (RBF kernel) and LR classifiers. […] The highest prediction precision, recall, accuracy, Area Under the Curve (AUC), specificity, and F1 scores of 0.92, 0.87, 0.92, 0.95, 0.95, and 0.89 are achieved with SVM (linear kernel) classifier using top ten principal features subset, which is, in fact higher than the baselines methods.

• #42 Diagnosis and Prediction of Large-for-Gestational-Age Fetus Using the Stacked Generalization Method

  https://www.mdpi.com/2076-3417/9/20/4317

  Therefore, the proposed scheme has the potential to establish an efficient LGA prognosis process using gestational parameters, which can assist paediatricians and experts to improve the health of a newborn using computer aided-diagnostic system. […] The primary motivation behind this research is to develop an accurate LGA classification model, which is capable of classifying an LGA fetus before birth using maternal biochemical indicators. […] The proposed scheme for the classification of LGA fetus using stacked generalization with an ensemble feature selection scheme proved best in the selection of useful features subset which can accurately identify a fetus with its gestational parameters. […] The significance of the proposed scheme is highlighted by comparing the results of the proposed scheme with existing state-of-arts LGA classification schemes. […] The proposed LGA classification scheme using stacking with an ensemble of feature selection and extraction schemes yielded better performance in terms of precision, AUC, recall, accuracy, specificity, and, F1 scores, when it is compared with existing state-of-the-art schemes.

• #43 Macrosomia Differential Diagnoses

  https://emedicine.medscape.com/article/262679-differential

  Problems associated with overdiagnosis: […] Delivery of an immature fetus for suspected macrosomia […] Surgical complications due to a prophylactic cesarean delivery for suspected macrosomia due to inaccurate ultrasound-based estimated fetal weight in a newborn that has appropriate growth for gestational age […] Surgical complications due to prophylactic cesarean delivery for suspected macrosomia when the frequency of shoulder dystocia is low, the risk of brachial plexus injury is lower, and the risk of permanent brachial plexus injury is lower still […] Problems associated with underdiagnosis: […] Shoulder dystocia in a newborn delivered by operative vaginal delivery found to be macrosomic at birth […] Shoulder dystocia and permanent nerve injury in a macrosomic fetus […] Failure to diagnose macrosomia and birth injury at delivery

• #44 Macrosomia Differential Diagnoses

  https://emedicine.medscape.com/article/262679-differential

  Problems associated with overdiagnosis: […] Delivery of an immature fetus for suspected macrosomia […] Surgical complications due to a prophylactic cesarean delivery for suspected macrosomia due to inaccurate ultrasound-based estimated fetal weight in a newborn that has appropriate growth for gestational age […] Surgical complications due to prophylactic cesarean delivery for suspected macrosomia when the frequency of shoulder dystocia is low, the risk of brachial plexus injury is lower, and the risk of permanent brachial plexus injury is lower still […] Problems associated with underdiagnosis: […] Shoulder dystocia in a newborn delivered by operative vaginal delivery found to be macrosomic at birth […] Shoulder dystocia and permanent nerve injury in a macrosomic fetus […] Failure to diagnose macrosomia and birth injury at delivery

• #45 Ultrasound Diagnosis of Fetal Macrosomia Found Inaccurate | MDedge

  https://medauth2.mdedge.com/content/ultrasound-diagnosis-fetal-macrosomia-found-inaccurate

  An ultrasound diagnosis of fetal macrosomia at term is inaccurate in the majority of cases, and this inaccuracy may be contributing to unnecessary cesarean deliveries, new data suggest. […] In an observational cohort study of 235 pregnancies at term in which ultrasound measurements led to a diagnosis of fetal macrosomia, only about a third of the infants were actually macrosomic at birth. Additionally, these pregnancies with ultrasound-diagnosed fetal macrosomia were more than twice as likely as all pregnancies in the population to end in cesarean delivery, according to results reported at the annual meeting of the Society of Obstetricians and Gynaecologists of Canada. […] Ultrasound-estimated fetal weight „is not very accurate, and we have to counsel patients on that, when they come to ultrasounds and they are worried that they are going to have this [enormous] monstrosity of a baby,” lead investigator Dr. Alese Wagner said in an interview. „You can tell them [that] most of the time, we are off.”

• #46 Ultrasound Diagnosis of Fetal Macrosomia Found Inaccurate | MDedge

  https://medauth2.mdedge.com/content/ultrasound-diagnosis-fetal-macrosomia-found-inaccurate

  She further recommended that physicians keep this new information in mind when it comes to recommending delivery interventions for a pregnancy in which the ultrasound suggests macrosomia. […] The study used the Hadlock formula for calculating weight from ultrasound fetal measurements, „which is supposed to be one of the better formulas for macrosomic infants,” she noted. […] However, they found that at the time of delivery, just 88 of these infants had an actual birth weight of at least 4,500 g, for a positive predictive value of merely 37.4%, according to results reported in a poster session. […] „It looked like most of the providers were overestimating weight,” she observed; the median estimated fetal weight was 4,693 g, whereas the median birth weight was 4,368 g. […] The mode of delivery was cesarean section in 66% of the pregnancies, compared with just 29% of all pregnancies in Calgary during the same period. „So its [more than] double, the percentage who are getting C-sections, on what is [an inaccurate weight],” said Dr. Wagner. […] „This opens up a lot of other areas that we can explore more within just this study,” such as whether maternal body mass index is affecting ultrasound accuracy, Dr. Wagner concluded.

• #47 Ultrasound Diagnosis of Fetal Macrosomia Found Inaccurate | MDedge

  https://medauth2.mdedge.com/content/ultrasound-diagnosis-fetal-macrosomia-found-inaccurate

  She further recommended that physicians keep this new information in mind when it comes to recommending delivery interventions for a pregnancy in which the ultrasound suggests macrosomia. […] The study used the Hadlock formula for calculating weight from ultrasound fetal measurements, „which is supposed to be one of the better formulas for macrosomic infants,” she noted. […] However, they found that at the time of delivery, just 88 of these infants had an actual birth weight of at least 4,500 g, for a positive predictive value of merely 37.4%, according to results reported in a poster session. […] „It looked like most of the providers were overestimating weight,” she observed; the median estimated fetal weight was 4,693 g, whereas the median birth weight was 4,368 g. […] The mode of delivery was cesarean section in 66% of the pregnancies, compared with just 29% of all pregnancies in Calgary during the same period. „So its [more than] double, the percentage who are getting C-sections, on what is [an inaccurate weight],” said Dr. Wagner. […] „This opens up a lot of other areas that we can explore more within just this study,” such as whether maternal body mass index is affecting ultrasound accuracy, Dr. Wagner concluded.

• #48 Macrosomia Differential Diagnoses

  https://emedicine.medscape.com/article/262679-differential

  Problems associated with overdiagnosis: […] Delivery of an immature fetus for suspected macrosomia […] Surgical complications due to a prophylactic cesarean delivery for suspected macrosomia due to inaccurate ultrasound-based estimated fetal weight in a newborn that has appropriate growth for gestational age […] Surgical complications due to prophylactic cesarean delivery for suspected macrosomia when the frequency of shoulder dystocia is low, the risk of brachial plexus injury is lower, and the risk of permanent brachial plexus injury is lower still […] Problems associated with underdiagnosis: […] Shoulder dystocia in a newborn delivered by operative vaginal delivery found to be macrosomic at birth […] Shoulder dystocia and permanent nerve injury in a macrosomic fetus […] Failure to diagnose macrosomia and birth injury at delivery

• #49 Macrosomia Differential Diagnoses

  https://emedicine.medscape.com/article/262679-differential

  Problems associated with overdiagnosis: […] Delivery of an immature fetus for suspected macrosomia […] Surgical complications due to a prophylactic cesarean delivery for suspected macrosomia due to inaccurate ultrasound-based estimated fetal weight in a newborn that has appropriate growth for gestational age […] Surgical complications due to prophylactic cesarean delivery for suspected macrosomia when the frequency of shoulder dystocia is low, the risk of brachial plexus injury is lower, and the risk of permanent brachial plexus injury is lower still […] Problems associated with underdiagnosis: […] Shoulder dystocia in a newborn delivered by operative vaginal delivery found to be macrosomic at birth […] Shoulder dystocia and permanent nerve injury in a macrosomic fetus […] Failure to diagnose macrosomia and birth injury at delivery

• #50 Evaluation and Management of Fetal Macrosomia – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33972073/

  Macrosomia results from abnormal fetal growth and can lead to serious consequences for the mother and fetus. […] In cases of suspected macrosomia, patients must be counseled carefully regarding a delivery plan, and Cesarean section should be considered when indicated. […] Techniques to assess for suspected macrosomia include clinical measurements, ultrasound, and MRI.

• #51 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold’s maneuvers). […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #52 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold’s maneuvers). […] Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes. […] Labor and vaginal delivery are not contraindicated for women with estimated fetal weights up to 5,000 g in the absence of maternal diabetes. […] With an estimated fetal weight more than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery. […] Although the diagnosis of fetal macrosomia is imprecise, prophylactic cesarean delivery may be considered for suspected fetal macrosomia with estimated fetal weights of more than 5,000 g in pregnant women without diabetes and more than 4,500 g in pregnant women with diabetes.

• #53 macrosomia Archives – The ObG Project

  https://www.obgproject.com/tag/macrosomia/

  The term fetal macrosomia implies growth beyond an absolute birth weight of 4000 grams or 4500 grams, regardless of gestational age. The risk of morbidity for both infants and mothers increases when the birthweight is between 4000 and 4500 grams. Risks for maternal and newborn morbidity rise considerably with birthweights >4500g. A correct diagnosis can only be made after weighing an infant at birth, as ultrasound prediction is not precise. […] Consider a prophylactic cesarean for suspected fetal macrosomia if the EFW (estimated fetal weight) is > 5000 grams in women without diabetes. […] Consider a prophylactic cesarean for suspected fetal macrosomia if the EFW is > 4500 grams in women with diabetes. […] Induction before 39w0d is not suggested for suspected fetal macrosomia as induction has not been shown to improve maternal or fetal outcomes.

• #54 macrosomia Archives – The ObG Project

  https://www.obgproject.com/tag/macrosomia/

  The term fetal macrosomia implies growth beyond an absolute birth weight of 4000 grams or 4500 grams, regardless of gestational age. The risk of morbidity for both infants and mothers increases when the birthweight is between 4000 and 4500 grams. Risks for maternal and newborn morbidity rise considerably with birthweights >4500g. A correct diagnosis can only be made after weighing an infant at birth, as ultrasound prediction is not precise. […] Consider a prophylactic cesarean for suspected fetal macrosomia if the EFW (estimated fetal weight) is > 5000 grams in women without diabetes. […] Consider a prophylactic cesarean for suspected fetal macrosomia if the EFW is > 4500 grams in women with diabetes. […] Induction before 39w0d is not suggested for suspected fetal macrosomia as induction has not been shown to improve maternal or fetal outcomes.

• #55 macrosomia Archives – The ObG Project

  https://www.obgproject.com/tag/macrosomia/

  Suspected fetal macrosomia is not a contraindication to a trial of labor after cesarean. […] No single formula based on ultrasound biometry performs significantly better than others for the detection of macrosomia more than 4,500 g. […] Similar to clinical estimates of fetal weight, ultrasonography can be used most effectively as a tool to rule out macrosomia, which may help avoid maternal and fetal morbidity.

• #56 Fetal macrosomia

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20372561

  A nonstress test measures the baby’s heart rate in response to his or her own movements. A fetal biophysical profile combines nonstress testing with ultrasound to monitor your baby’s movement, tone, breathing and volume of amniotic fluid. […] If your baby’s excess growth is thought to be the result of a maternal condition, your health care provider might recommend antenatal testing starting as early as week 32 of pregnancy. […] Note that macrosomia alone is not a reason for antenatal testing to monitor your baby’s well-being.

• #57 Large for Gestational Age – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=large-for-gestational-age-90-P02383

  Babies are weighed within the first few hours after birth. The weight is compared with the baby’s gestational age and recorded in the medical record. […] Before the baby is born, healthcare providers use the term fetal macrosomia instead of LGA. […] If ultrasound exams during pregnancy show that your baby is very large, your healthcare provider may recommend early delivery.

• #58 Macrosomia Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/262679-workup

  A glucose tolerance test at 24-28 weeks of gestation screens for gestational diabetes, a known risk factor for macrosomia. Identification and treatment of gestational diabetes has been shown in randomized controlled trials to decrease fetal birth weight, thereby reducing risk of macrosomia. […] Neonatal evaluation for hypoglycemia, polycythemia, hyperbilirubinemia, and electrolyte abnormalities is indicated in all macrosomic newborns because maternal hyperglycemia is the most common cause and sometimes this diagnosis is not made in the mother prior to delivery of her child. […] Ultrasound measurements to obtain estimated fetal weights are indicated when clinical assessments indicate a uterine size greater than that expected for the gestational age. An examination within 1-2 weeks of delivery showing an abdominal circumference of 35 cm or larger should alert the clinician to anticipate a fetus with a birthweight of 4000 g or more. The definitive diagnosis can only be made after delivery of the neonate.

• #59 Large-for-Gestational-Age (LGA) Newborns – Children’s Health Issues – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/children-s-health-issues/general-problems-in-newborns/large-for-gestational-age-lga-newborns

  A newborn who weighs more than 90% of newborns of the same gestational age at birth (above the 90th percentile) is considered large for gestational age. […] Doctors take measurements of the mother’s abdomen and use ultrasounds to take measurements of the fetus to help estimate the fetus’s weight. […] Ultrasound can be used to assess the size of the fetus and estimate fetal weight to confirm the large-for-gestational-age (LGA) diagnosis. […] After birth, LGA is diagnosed by assessing the gestational age and the weight of the newborn. […] LGA newborns are assessed for any complications. Blood sugar is measured to detect hypoglycemia, and doctors do a thorough examination to look for birth injuries and structural or genetic abnormalities.

• #60 Fetal macrosomia – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/fetal-macrosomia/symptoms-causes/syc-20372579

  Fetal macrosomia poses health risks for you and your baby both during pregnancy and after childbirth. […] Fetal macrosomia can cause a baby to become wedged in the birth canal (shoulder dystocia), sustain birth injuries, or require the use of forceps or a vacuum device during delivery (operative vaginal delivery). […] Fetal macrosomia increases the risk that your uterine muscles won’t properly contract after you give birth (uterine atony). […] A baby diagnosed with fetal macrosomia is more likely to be born with a blood sugar level that’s lower than normal. […] If your baby is diagnosed with fetal macrosomia, he or she is at risk of developing metabolic syndrome during childhood. […] Research shows that exercising during pregnancy and eating a low-glycemic diet can reduce the risk of macrosomia.

• #61 ACOG Issues Guidelines on Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0701/p169.html

  The Committee on Practice BulletinsObstetrics of the American College of Obstetricians and Gynecologists (ACOG) has issued new clinical management guidelines on fetal macrosomia. ACOG Practice Bulletin No. 22, which replaces Technical Bulletin No. 159 issued in September 1991, appears in the November 2000 issue of Obstetrics and Gynecology. These guidelines discuss risk factors and complications, and suggest clinical management for the pregnancy with suspected fetal macrosomia. […] Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise. […] According to the ACOG committee, the risk factors (excluding preexisting diabetes mellitus) for fetal macrosomia, in decreasing order of importance, are as follows: a history of macrosomia, maternal prepregnancy weight, weight gain during pregnancy, multiparity, male fetus, gestational age more than 40 weeks, ethnicity, maternal birth weight, maternal height, maternal age younger than 17 years and a positive 50-g glucose screen with a negative result on the three-hour glucose tolerance test.

• #62 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  Fetal macrosomia, arbitrarily defined as a birth weight of more than 4,000 g (8 lb, 13 oz) complicates more than 10 percent of all pregnancies in the United States. It is associated with increased risks of cesarean section and trauma to the birth canal and the fetus. Fetal macrosomia is difficult to predict, and clinical and ultrasonographic estimates of fetal weight are prone to error. […] Maternity care professionals frequently encounter pregnant patients in whom fetal macrosomia is suspected. Recognizing the special risks of these pregnancies, clinicians have attempted to find accurate ways of predicting fetal weight and have sought interventions, including elective cesarean section and induction of labor to optimize the maternal and fetal outcomes. […] The most clinically useful definition of macrosomia is a weight below which macrosomic complications, such as shoulder dystocia, do not occur.

• #63 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  With the exception of optimal blood glucose management in pregnancies complicated by diabetes, little is known about the prevention of macrosomia. […] Macrosomia remains a common complication of pregnancy; its prediction is imperfect, and there are no reliable interventions to improve outcome in uncomplicated pregnancies.

• #64 ACOG Practice Bulletin 173: Fetal Macrosomia – OPQIC

  https://opqic.org/acog-practice-bulletin-173-fetal-macrosomia/

  Suspected fetal macrosomia is encountered commonly in obstetric practice. The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Level A). Suspected fetal macrosomia is not an indication for induction of labor because induction does not improve maternal or fetal outcomes (Level B). With an estimated fetal weight of greater than 4,500 g, a prolonged second stage of labor or arrest of descent in the second stage is an indication for cesarean delivery (Level B). Barring unusual circumstances, cesarean delivery should be performed for midpelvic arrest of the fetus with suspected macrosomia (Level B). As with clinical estimates of fetal weight, the true value of ultrasonography in the management of expected fetal macrosomia may be its ability to rule out the diagnosis, which may help to avoid maternal morbidity (Level B).

• #65 Management of Suspected Fetal Macrosomia | AAFP

  https://www.aafp.org/pubs/afp/issues/2001/0115/p302.html

  With the exception of optimal blood glucose management in pregnancies complicated by diabetes, little is known about the prevention of macrosomia. […] Macrosomia remains a common complication of pregnancy; its prediction is imperfect, and there are no reliable interventions to improve outcome in uncomplicated pregnancies.

• #66 SciELO – Public Health – Macrosomia Predictors in Infants Born to Cuban Mothers with Gestational Diabetes Macrosomia Predictors in Infants Born to Cuban Mothers with Gestational Diabetes

  https://www.scielosp.org/article/medicc/2015.v17n3/27-32/

  Initial overweight or obesity in pregnancy, excess pregnancy weight gain, inadequate glycemic control, hypertriglyceridemia, and FAC 75th percentile and fetal weight 90th percentile for gestational age 28 weeks, were significantly associated with macrosomia in IMGDs and can therefore be considered predictors of this complication.

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