Fetal Macrosomia

Asheber Gaym M.D.

January 2009
 Outline

• Define birth weight for gestational age

classifications
• Discuss definitions of fetal macrosomia
• List possible etiologies of fetal macrosomia
• Discuss complications of fetal macrosomia

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 Birth Weight for Gestational Age Categories

Category Description

Small for gestational age (SGA) Birth weight is less than the tenth percentile
for the gestational age of the neonate. Some
of these neonates are growth restricted.
Appropriate for gestational age (AGA) Birth weight falls between the tenth and
ninetieth percentile for the gestational age of
the neonate.
Large for gestational age (LGA) Birth weight falls above the ninetieth
percentile for the gestational age of neonate.
Macrosomic fetuses fall in this category.
Birth weight needs to be considered in conjunction with gestational age and not by
itself. SGA and LGA fetuses and neonates are associated with adverse outcomes
compared to AGA fetuses. Accurate gestational age assessment is important for the
correct diagnosis of birth weight to gestational age discrepancies.

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 Definitions

• Different birth weight cut offs are used to

define fetal macrosomia
• A birth weight of 4000, 4500 or even 5000
grams are used to define macrosomia
• The American College of Obstetrics and
Gynecology uses the 4500 grams cut off to
define macrosomia
• Low resource settings use the 4000 grams cut
off to define macrosomia

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 Etiology of Fetal Macrosomia

• Mostly idiopathic and no specific cause can be

identified
• Known causes:
– Maternal diabetes mellitus
– Beckwiths syndrome
– Increasing maternal parity
– Post term pregnancy

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 Complications of Fetal Macrosomia

• Malpresentations/malpositions
• Fetopelvic or Cephalopelvic disproportion
• Obstructed labor
• Labor abnormalities
• PROM/Infections
• Increased risk of cord accidents
• Neonatal metabolic complications such as hypoglycemia
• Birth trauma
• Risk of vaginal and abdominal operative delivery
• Increased perinatal and maternal morbidities and
mortalities
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