Macrosomia

Description:

The macrosomia of a fruit is such state when (depending on the used definition) the weight of a fruit makes more than 4000 — 4500 g, or the 90th percentile for this gestational age. It is important to diagnose timely a macrosomia and, whenever possible, to remove the causes which are its cornerstone. The doctor-obstetrician has to expect potential problems of delivery by a large fruit in natural patrimonial ways. Including lengthening of the second stage of childbirth, a dystocia of a coat hanger and any injury of a fruit and mother.

Macrosomia reasons:

The macrosomia is caused by obesity, diabetes of mother and an excess increase of body weight during pregnancy. Suspicion of a macrosomia usually arises in that case when height of standing of an uterine fundus more than on 4 cm exceeds the indicator characteristic of this duration of gestation.

Diagnosis:

The diagnosis is confirmed by means of an ultrasonografiya. The differential diagnosis should be carried out with big, but nevertheless a normal fruit, polycarpous pregnancy, a hydramnion, a leiomyoma of a uterus or other tumors of a pelvic cavity, and to earlier durations of gestation — with a vesical drift.

Treatment of a macrosomia:

Prenatal observation is directed to identification and treatment of the reason of a macrosomia. Conducting childbirth depends on the choice of a way of delivery. Some specialists consider that the macrosomia of a fruit is the absolute indication to Cesarean section. Their opponents claim that the operational risk for mother is not justified as the probability of perinatal complications does not depend on a way of delivery. The standard indication to Cesarean section at a macrosomia is the mass of a fruit of 4000 g at a diabetes mellitus at mother or 4500 g in the absence of diabetes is at mother.

Choosing conservative delivery, the obstetrician has to be ready to assistance at emergence of an allotopia of a coat hanger. The risk of the complicated birth of a coat hanger can be estimated by means of ultrasonography, comparing a head circle to a fruit thorax circle. At a dystocia of a coat hanger Mac-Robertson's reception is used: the woman in labor bends legs in hip joints and presses knees to a thorax. At the same time press on suprapubic area. It is necessary to avoid pressure upon an uterine fundus as it often leads to jamming of a front plechik. If front плечико it is not possible to remove, carry out a perineotomy and remove back плечико.

If these receptions are unsuccessful — return back the head of a fruit to the vulval canal and carry out the emergency Cesarean section.