Fetal+Macrosomia

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** CCRMC OBGYN **** Prenatal Guideline ** Consultation available 24 hours per day from OB on-call at 925-370-5608 or via page/amion, via inbasket to OB dept member or by calling Perinatologist at 510-444-0790 during the day and 510-204-1572 after hours. Consultation appointments or transfer of care to more experienced prenatal clinician available at major clinics sites—see consultation guidelines for more information.

= ** Fetal Macrosomia ** =

Consider 37-39 week ultrasound for EFW (estimated fetal weight) if suspected macrosomia:
 * DM particularly if pregestational/ A2/ poor control
 * Obesity/elevated maternal BMI
 * Measuring large on fundal height
 * Subjective maternal sense of large baby

To improve accuracy it is best to get EFW sonogram __>__37-39 wks EGA to avoid need for extrapolation of growth from time of ultrasound to presentation to L&D.

-only increases cesarean delivery rate with no improvement in outcomes
 * __Induction of labor is not indicated for suspected macrosomia__**

Offer primary section if >5000gm EFW in non diabetic mother, > 4500gm in DM or GDM mother to decrease risk of fetal birth injury

If prior fetal birth injury or difficult delivery, consider consult with OB staff for route of delivery even if EFW below the 5000/4500gm standards listed above