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Definition LGA

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


Risks of LGA

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


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

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.


Risk factors for LGA

- 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.