SEARCH RESULTS FOR: Macrosomia-Pathogenesis-and-Complications

Macrosomia Pathogenesis and Complications

Macrosomia: Pathogenesis and complications Fetal congenital disorders (e.g. Fragile X syndrome, Weaver syndrome) Genes encoding cellular growth are mutated and induce ↑ cell proliferation Fetus with XY chromosomes Y chromosome predisposes fetus to excess growth factor Pregnancy longer than 42 weeks Birth weight ↑ as gestational age ↑ Pregnant parent with BMI > 30 kg/m2 ↑ Central adipose tissue release insulin- desensitizing factors ↑ Insulin resistance promotes hepatic glucose production Macrosomia Parent has previously had ≥ 2 births Average birth weight ↑ with each successive pregnancy Pregnant parent with type 2 diabetes or gestational diabetes (1-hour 50 g glucose challenge test >140 mg/dL at 24-28 weeks gestation) Parent’s glucose-rich blood is carried to the fetus through the placenta ↑ Levels of glucose present in fetal circulation promotes excessive growth (Fetus grows beyond absolute birth weight (> 4000 g) regardless of gestational age) Fetal dysregulation of glucose and fetal programming of later adiposity Metabolic syndromes (e.g. hypoglycemia, hyperinsulinemia) ↑ Insulin levels delay pulmonary maturation Respiratory distress Large fetal size in the uterus Cardiac mass ↑ in proportion to body size Fetal cardiac remodeling (e.g. ↑ left ventricular mass) Uterine muscle wall stretched beyond optimal range Uterine rupture Parent pushes fetus into birth canal Maternal nutrition supply is unable to meet fetus’ increased metabolic demands ↑ Uterine distension prevents uterine muscles from contracting (uterine atony) Fetus takes longer to descend through the birth canal Large fetal size overstretches pelvic structures Perianal trauma (e.g. lacerations to pelvic floor, vagina, rectum) Less space in birth canal prevents the parent from delivering the anterior fetal shoulder after the fetal head Shoulder dystocia (baby’s shoulder stuck during birth) Arrested labour (slow cervical dilation) Insufficient space in birth canal to deliver fetus Assisted vaginal birth/ cesarian section Protracted labour (slow fetal descent) Stillbirth Fetal distress (↓ heart rate) Lack of mechanical contraction of the spiral arteries, normally provided by uterine muscles Blood loss (≥ 500-1000 mL 24 hours post birth) Postpartum hemorrhage Authors: Akaya Blair Reviewers: Dasha Mori Michelle J. Chen Dr. Ian Mitchell* * MD at time of publication ↑ Frequency/ prolonged admission (≥ 3 days) to neonatal intensive care unit Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Mar 21, 2024 on www.thecalgaryguide.com