Population: Pregnant women with fetal macrosomia.
Organization
ACOG 2020
Recommendations
–Diagnose macrosomia using ultrasound. Prediction of birth weight is imprecise by ultrasonography or clinical measurement. Accuracy of EFW by ultrasound biometry is no better than abdominal palpation.
–Recommend aerobic and strength-conditioning exercise during pregnancy to reduce the risk of macrosomia.
–Optimize maternal glycemic control.
–Discuss risks and benefits of vaginal births and cesarean births based on the degree of suspected macrosomia.
• Scheduled cesarean birth may be beneficial for newborns with suspected macrosomia with an EFW >5000 g in women without diabetes and an EFW of ≥4500 g in women with diabetes.
• Suspected fetal macrosomia is not an indication for induction of labor before 39 wk of gestation. There is insufficient evidence that benefits of reducing shoulder dystocia risk outweigh harms of early delivery.
Practice Pearl
• Historically, macrosomia has been defined as >4000 g or 4500 g. No universally accepted definition exists.
Source
–ACOG. Practice Bulletin No 216. Macrosomia. 2020.