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Macrosomia-Fetal-Complications

Macrosomia: Overview of Fetal Complications 1Macrosomia Authors: Brielle Cram Reviewers: Nicola Adderley, Crystal Liu, Yan Yu*, Danielle Nelson* * MD at time of publication (A fetus larger than 4000- 4500 grams) Size discrepancy between fetal shoulders and maternal pelvic inlet Anterior shoulder becomes impacted behind the symphysis pubis during delivery Shoulder Dystocia (↑risk in infants of diabetic mothers – see slide on Gestational Diabetes) Injuries acquired as a result of the birthing process in an infant with shoulder dystocia ↑ incidence of preterm birth Surfactant deficiency Respiratory Distress Syndrome Umbilical cord compression ↓ delivery of oxygenated blood to fetus Hypoxia/Asphyxia Infant gasping Perinatal aspiration of stained amniotic fluid Meconium Aspiration Syndrome ↑ incidence of cesarean deliveries ↓ duration/absence of labour ↓ release of maternal epinephrine and glucocorticoids ↓ activation of epithelial sodium channels on type II pneumocytes Delayed resorption of fetal lung fluid Transient Tachypnea of the Newborn Notes ↑ oxygen demands Fetal hypoxia ↑ production of erythropoetin Polycythemia Neonatal Jaundice Maternal diabetes ↑ intrauterine exposure to excessive nutrients and glucose 2Fetal Hyperinsulinism ↑ glucose utilization and suppression of hepatic glucose production Termination of the maternal glucose supply at delivery Hypoglycemia Brachial Plexus Injury Clavicular Fracture Humeral Fracture 1. Complications of macrosomia ↑ with birth weight. Risk of stillbirth ↑ above 5 kg 2. Most common in the setting of poorly controlled maternal diabetes; however, hyperinsulinism may be absent if macrosomia is secondary to a different etiology (e.g. post-term fetus, genetic conditions). Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published September 22, 2019 on www.thecalgaryguide.com