LGA

• Large for gestational age:

  • Also called macrosomia
  • When the weight of the newborn is more than 4.5kg at birth
  • During pregnancy when an estimated fetal weight is above the 90th centile
• Causes of macrosomia:

  • Constitutional
  • Maternal diabetes
  • Previous macrosomia
  • Maternal obesity or rapid weight gain
  • Overdue
  • Male baby
• Risks to mother:

  • Shoulder dystocia
  • Failure to progress
  • Perineal tears
  • Instrumental delivery or caesarean
  • Postpartum haemorrhage
  • Uterine rupture (rare)
• Risks to baby:

  • Birth injury - Erbs palsy, clavicular fracture, fetal distress and hypoxia
  • Neonatal hypoglycaemia (if secondary to maternal diabetes)
  • Obesity in childhood and later life
  • Type 2 diabetes in adulthood
• Investigations for a large for gestational age baby are:

  • Ultrasound to exclude polyhydramnios and estimate the fetal weight
  • Oral glucose tolerance test for gestational diabetes