December 2003 · Vol. 15, No. 12Fetal macrosomia: 3 management dilemmas
This condition—and its most-feared complication—is impossible to predict with accuracy. What’s more, there is no evidence supporting a specific intervention. So, what is the best approach? Dr. Resnik offers practical observations.
ROBERT
RESNIK,
MDDr. Resnik is professor of reproductive medicine at the UCSD School of Medicine, San Diego, Calif. He is coeditor of Maternal-Fetal Medicine, a foremost reference text.
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KEY POINTS
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Women with borderline glucose tolerance, as well as those with normal glucose tolerance but mildly hyperinsulinemic fetuses, are at risk of delivering macrosomic infants.
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Maternal risk factors include obesity, excessive weight gain, and a history of delivering a macrosomic infant.
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The precision of ultrasound measurements declines as fetal weight increases.
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Estimating birth weight does not accurately predict the risk of brachial plexus injury.
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Neither routine cesarean delivery nor induction of labor is appropriate routine management for suspected macrosomia.
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Every clinician would like to avoid vaginal delivery of a macrosomic infant and the attendant potential for shoulder dystocia and permanent brachial plexus injury. Unfortunately, research findings offer little specific guidance, and we continue to wrestle with these dilemmas:
Patient care is thus based on estimating the likelihood of macrosomia and its complications, evaluating the risks and benefits of cesarean versus vaginal delivery in each woman, and being prepared for optimal labor management.
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