Management of large‐for‐gestational‐age pregnancy in non‐diabetic women

Key content Over the last two to three decades there has been a 15–25% increase in many countries in the number of women giving birth to large infants. Rates of shoulder dystocia and caesarean birth rise substantially at 4000 g and again at 4500 g. There is an increase in maternal and neonatal morbidity associated with fetal macrosomia. Serial measurement of fundal height adjusted for maternal physiological variables substantially improves antenatal detection. Sonographic assessment of fetal weight is frequently inaccurate. Induction of labour for suspected macrosomia in non‐diabetic women has not been shown to reduce the risk of caesarean section, instrumental delivery or perinatal morbidity. Learning objectives To identify the risks associated with fetal macrosomia and to be aware of the long‐term implications. To understand the limitations of predictive tools. To be able to take an informed approach to managing the macrosomic fetus. Ethical issues To what extent should the fear of medico‐legal action influence obstetricians' management of suspected fetal macrosomia? What advice should clinicians give women regarding modes of delivery? Please cite this article as: Aye SS, Miller V, Saxena S, Farhan M. Management of large‐for‐gestational‐age pregnancy in non‐diabetic women. The Obstetrician & Gynaecologist 2010;12:250–256.