Obstetricians and sonographers must keep careful track of the baby’s growth throughout the pregnancy. A baby who is developing too slowly or growing too quickly may need intervention in order to prevent serious medical complications. The medical term for a baby who is larger than she should be is macrosomia, also known as “big baby syndrome.”
A large baby can present more challenges during pregnancy, labor, and delivery than an average sized one. Excessive birth weight is associated with increased risk of injury to both the mother and child.
At The Becker Law Firm, our Ohio birth injury attorneys understand the risks associated with a large baby and the standards of care obstetrical caregivers must meet in managing a high-risk pregnancy, labor, and delivery involving a suspected large fetus.
Contact us today if your child suffered birth injuries as a result of macrosomia. We can be reached online or by phone at (440) 252-4399.
Estimating the Size of the Fetus
The size of the fetus is estimated from ultrasound images taken at various stages during pregnancy. Malpractice can occur if obstetrical caregivers fail to properly interpret ultrasound tests or fail to properly estimate fetal weight based on the ultrasound.
There is a large range of error in estimating fetal weight by ultrasound alone. Doctors must also consider other factors, including the mother’s height and weight, obstetrical history, size of the maternal pelvis, and the presence of gestational diabetes.
There are several warning signs that should put careful obstetricians on notice that a baby may be macrosomic:
- Gestational diabetes
- Pre-pregnancy diabetes
- Obese mother (BMI > 30 or over 198 lbs.)
- Rapid/excessive pregnancy weight gain
- Prior delivery of a “large for gestational age” baby or macrosomic baby
- Post-term pregnancies (those that go beyond 42 weeks)
- Advanced maternal age
- Multiple gestations
- Male baby
When any of these warning signs are present, obstetricians should check to see if macrosomia is a true concern. Doctors can check the baby’s size by pushing on the mother’s stomach using a technique known as Leopold’s maneuver. If large enough, an ultrasound will be used to determine the baby’s size, though these scans may be off by as much as fifteen percent. Obstetricians and sonographers should double-check the date of conception to ensure an accurate calculation.
Treatment of Suspected Large Fetus
The underlying cause of macrosomia frequently must be managed, particularly in the case of diabetes. Obese women should be instructed to gain less weight and may require referral to a dietician or nutritionist.
Some doctors choose a cesarean section or induction for babies who are large for gestational age (before they become macrosomic), but that runs the risk of injuries caused by prematurity and underdeveloped lung function. If the pregnancy is allowed to run its course or if induction is attempted, the doctor should be prepared to deal with a shoulder dystocia situation and should be prepared to deliver by cesarean section in the event of an emergency.
Risks of Macrosomia & LGA
Newborns above the 90th percentile for weight at their gestational age are considered to be large babies. This is known as being “large for gestational age,” or “LGA.”
The term “fetal macrosomia” is used to describe babies that are exceptionally large regardless of their gestational age. A newborn will be diagnosed with fetal macrosomia if her birth weight in excess of 8 pounds, 13 ounces. Babies weighing in excess of 9 pounds, 15 ounces are considered to be much larger than average.
Macrosomic babies are at risk for the following complications and injuries:
- Low blood sugar (hypoglycemia) – Large babies are at greater risk of developing hypoglycemia. The effects of neonatal hypoglycemia can range from benign discomfort to serious complications in the cardiopulmonary and central nervous systems.
- Childhood obesity – Obese children are at increased risk for high cholesterol, high blood pressure, and diabetes. Obese children are also more likely to be obese as adults.
- Metabolic syndrome – Metabolic syndrome involves a combination of increased blood pressure, high blood sugar, and excess body fat. Together, these increase the baby’s risk of diabetes, heart disease, and stroke.
- Shoulder dystocia – Shoulder dystocia is a condition that occurs during childbirth where the baby’s shoulders get stuck behind the maternal symphysis or make impact with the sacral promontory. Shoulder dystocia can present serious risks for both mother and child and may require an emergency C-section.
Mothers of macrosomic babies have a greater than normal risk of:
- Delivery complications – High birth weight is closely correlated with increased complications during delivery. For vaginal delivery, use of forceps or vacuum extraction may be required. If these fail, a C-section may be required.
- Birth canal injuries and excessive bleeding – Tissue and perineal muscle tears are more common among mothers who give birth to babies with fetal macrosomia. Giving birth to a large baby can also make your uterine muscles take longer to contract after birth, which can lead to excessive bleeding.
- Uterine rupture – Women who have had prior C-sections or uterine surgeries are at greater risk for uterine rupture when giving birth to a large baby.
If you have questions about LGA or macrosomia, or if you experienced complications while giving birth to a large baby and need help understanding what went wrong, the attorneys at The Becker Law Firm are here to help. We can help you review your situation and determine if a hospital error or medical malpractice may be to blame for the injuries suffered by you or your child.