Evaluation of antepartum fetal well-being by measuring growth

All patients at risk for an infant who is large for gestational age should be screened with early sonography for confirmation of gestational age. If growth appears to be normal, further follow-up is done according to clinical indications. If growth is excessive, measurements of abdominal circumference should be made as well as a search for polyhydramnios and congenital anomalies. The mother should be screened for diabetes. If the tests on the mother are normal, the glucose screen should be repeated in the third trimester. If the mother is identified as being diabetic, blood sugars must be adequately controlled. Determination of ultrasonograms are indicated at 37 to 38 weeks to identify macrosomia. If fetal size is normal, the patient should be followed as otherwise appropriate for a diabetic patient. If macrosomia is present and the fetus is of known mature gestational age, atraumatic delivery is planned. If macrosomia is present but gestational age is unclear, amniocentesis should be done to determine fetal pulmonary maturity prior to a planned delivery. In the management of the delivery of a macrosomic fetus, use of cesarean section is appropriate, particularly in the presence of a prolonged second stage or poor progress of labor. Delivery by midforceps should be avoided whenever possible.