Large fetus during pregnancy: causes, childbirth orcesarean section

Update: October 2018

There is a perception among the population that a large fetus weight speaks of
health and strength, but only mothers who gave birth to “warriors” and doctors
they know the difficulties they face in the process
childbirth and after the birth of a child. If you believe the statistical
According to the data, the birth of a large child is noted in 5–10% of all
childbirth.

Definition of concepts

On large fruit or macrosomia say when it
fetal indicators of intrauterine development significantly
exceed the established rate for a specific period of pregnancy,
or the mass of a newborn is 4 kg or more. In addition to weight
The child’s height is also taken into account, so a normal baby’s height
is in the range of 48 – 54 cm, while the length of the fruit with a large
weight is 54 – 56 cm, and in some cases reaches 70
cm.

If the mass of a child at birth is 5 kg or more, then they talk about
giant fruit. The birth of giant children is less common than
крупных, и имеет соотношение 1/3000 childbirth.

The reasons

Why a child is born big is due to many reasons
that may be due to both the peculiarities of the woman’s body,
and the individual traits of the developing baby in the womb. To such
факторам relate:

Genetic predisposition

It is noted that in the birth of a large child plays a role and
heredity. Physically developed and tall parents
have a greater ability to produce large
baby

Increase in pregnancy duration

AT норме беременность продолжается 38 – 41 неделю (cm.
pregnancy duration calculator). If the gestation period exceeds
the upper limit of the norm, talking about postponing pregnancy,
which can be true and false. With true retouching
a child is born with obvious signs of perenosheniya: dry, without
original lubricant skin, wrinkling, water have a greenish or
grayish shade, and their number is reduced. Similar phenomena
due to aging of the placenta, the formation of multiple
calcifications, reducing its functions. Lack of oxygen and
nutrients leads to the development of placental insufficiency,
hypoxia and even malnutrition of the fetus.

Diabetes in women

The birth of a large child (or an ultrasound more than the term
pregnancy) may be due to diabetes mellitus
mother or his development during gestation (gestational diabetes).
Children in women with diabetes are born with a number of characteristic
signs of what is called diabetic fetopathy. Heavy weight
the fetus is the result of hormonal storm and constant surges
уровня глюкозы в крови women. Characteristic sign of diabetic
fetopathy is an overweight gain in baby weight after 20
weeks of pregnancy on the background of developing polyhydramnios.
Accordingly, the child is born though large, but initially
unhealthy. Pregnant women with diabetes are hospitalized no later than
32 weeks, examine and decide on the timing and methods
delivery

Rhesus-conflict pregnancy

One of the reasons that determine the size of the fetus more
term, is rhesus conflict pregnancy. This complication
gestation occurs when carrying a child with a positive
Rh factor for a woman with a negative Rh. ATследствие
which the unborn child develops hemolytic disease, which
characterized by anemia and jaundice, and in extremely severe forms to them
joins puffiness what is called the edematous form
hemolytic disease. At the same time in the cavities of the fetus (stomach, chest
cage) accumulates fluid, and the liver and spleen significantly
increase in size. Massive swelling and hepatosplenomegaly and
determine the large weight of the child.

Features of the placenta

Also provoke the formation of a large baby can and
структурные и функциональные особенности плаценты (cm. также
degree of maturity of the placenta). Often at the birth of a child with a large
body mass marked placenta of large size and thickness (5 and
more cm). A thick and massive placenta contributes to intense
exchange of nutrients and trace elements, which accelerates the development
fetus. In addition to increasing the volume of circulating blood and intensive
blood supply to the child, there are bursts of placental hormones,
which indirectly affects the metabolism in the maternal organism and
усиливает рост и развитие baby

Subsequent pregnancies ending in childbirth

A directly proportional relationship between the number of
childbirth and body weight of children born. After the second, third and so
further genera form a large fruit, which is about 30%
exceeds the size and weight of the firstborn. ATрачи данный факт объясняют двумя
moments.

  • ATо-первых, имеет значение психологический фактор, женщина,
    nursing a second / third child is familiar with the flow processes
    pregnancy and childbirth, more balanced and calm.
  • ATо-вторых, крупные размеры малыша при следующих беременностях
    due to the best conditions of intrauterine nutrition due to
    developed bloodstream nets in the uterine wall.
  • Also conditions for intrauterine growth and development of the second
    the baby is much better due to the greater distensibility of the uterus and
    slight resistance to the abdominal muscles.

The nature of nutrition pregnant

Not the last role in increasing the weight of the child is played by nutrition and
a woman’s lifestyle, especially after the 20th week of pregnancy (see
how not to gain extra weight during pregnancy). Hypodynamia growing
belly, high-calorie foods (consumption of baking,
sweets, pasta) leads not only to the accumulation of fatty tissue
in the expectant mother, but also provokes macrosomia in the fetus (see what can
and what can not be during pregnancy).

Obesity

Excessive weight of the future mother also plays a role. it
due not only to poor nutrition of the pregnant woman, but also
impaired lipid metabolism in her body that provokes
violation of the metabolism of proteins, fats and carbohydrates in the fetus,
intrauterine liver damage and pancreas and activation
compensatory reactions in the placenta. All these factors contribute
rapid growth and weight gain of the fetus. In case of obesity 1 degree
large fruit is born in 28% of pregnant women, with a 2 degree probability
large child increases to 32%, and at grade 3 to 35%.

Medication

Uncontrolled intake of certain medications for pregnant women,
which improve uteroplacental circulation and activate
anabolic processes (eg, gestagens, actovegin) also
promote weight gain.

Other factors

Age of a woman (younger than 20 or older than 34 years old), presence
inflammatory processes of the reproductive organs
Cycles can also affect sizes.

Large fetus: signs and diagnosis

If during pregnancy a woman has a big belly, it is not
necessarily evidence of a large child. Should be excluded
multiple pregnancy and high water (many pregnant
neglect the passage of ultrasound in such an important period of life).

By 38 weeks of pregnancy, and sometimes earlier, by clinical
The manifestations of large fetal size are objective data
received during a visit to the obstetrician. With each appearance in the female
consultation with a pregnant woman measures body weight, an increase of 500 grams.
weekly on the background of missing edema and other signs of preeclampsia
makes the doctor suspect the baby’s heavy weight.

In the case of a large fetus during pregnancy signs
are determined by the size of the woman’s abdomen (the circumference and height of the bottom
uterus), evidence of this are larger than:
Abdominal circumference more than 100 cm, and the height of the bottom of the uterus more than 40.

Estimated weight of the fetus is calculated by the formula: the coolant multiplies
on WYD.

Since the baby with more weight in utero takes more
places, the internal organs of the woman are subjected to greater compression and
infringement and experiencing significant stress. As a result
pregnant woman notes frequent urination, heartburn (casting
gastric contents into the esophagus), constipation and shortness of breath. Uterus large
sizing presses on the inferior vena cava, which can provoke
fainting lying flat on his back. Is increasing
load on the musculoskeletal system, which is manifested by pain in
legs, lower back, spine and ribs. Possible occurrence
or worsening of varicose leg disease. Also high
the likelihood of stretch marks on the abdomen and increase the tone
uterus.

Of great importance in the diagnosis of large fetus has ultrasound, with
measuring fetal fetal data and determining
his estimated weight. The circumference of the head and abdomen are measured.
length of the femur and humerus. Big head and significant
abdominal size, enlargement of the liver and spleen, detection of fluid in
body cavities speaks of an edematous form of hemolytic disease.

Course of pregnancy

Pregnancy in women with large fetus occurs, as a rule,
without complications. All the described complications (fainting, problems with
digestive tract and shortness of breath) develop to 38 – 40 week
pregnancy is a large fetus. High probability of development
placental insufficiency and progressive hypoxia in
result of a mismatch of uteroplacental blood flow and fast
increasing baby weight. To the features of pregnancy
relate:

  • thorough examination to exclude polyhydramnios and
    multiple pregnancies;
  • eliminate diabetes mellitus – conducting a tolerance test
    glucose and endocrinologist consultation;
  • calculation by ultrasound and the size of the abdomen of a pregnant
    estimated fetus weight;
  • physiotherapy;
  • correction of diet (exclude easily digestible carbohydrates and
    refractory fats);
  • cancellation or restriction of taking anabolic drugs.

Childbirth

�“How to give birth if a large fruit?” – the future is wondering
moms. The answer is not the course of childbirth, which at large
sizes have their own characteristics. Spontaneous childbirth
significant sizes are often complicated by the following
circumstances:

Clinically narrow pelvis

This complication develops when the fetus has a large
head and even with full disclosure (10 cm) uterine throat, it is not
advances that called the size mismatch of the head of the pelvis
women. Characteristically, the size of the maternal pelvis can be
within normal limits, but birth is still difficult, even with good and
strong fights. If there is an anatomical constriction of the pelvis
(the sizes of the pots are shortened by 1 – 1.5 cm or more) the question of
cesarean section.

Late discharge of water

The early discharge of water (before the opening of the pharynx by 8 cm) is due to
high standing baby’s head, so it is due to the large size
can not cling to the entrance to the small pelvis and move, and
the delineation of water on the front (fetal bladder) and the rear is not
going on. Early discharge of water is dangerous loss of the umbilical cord loop
or small parts of the child (leg, handle). In addition, this
complication slows the process of uterine opening pharynx, which lengthens
1 period of labor and exhausts the woman in labor. If anhydrous period
last 12 hours or more, the risk of intrauterine
инфицирования малыша и uterus. When the umbilical cord or part falls out
fetal immediate immediate delivery.

Anomalies of generic forces

Birth large fruit is often complicated by anomalies
generic activity. Protracted labor leads to a decrease in
intensity and frequency of contractions (weakness of generic forces develops,
both primary and secondary). The child begins to suffer
intrauterine hypoxia increases (first, fetal heartbeat
quickens – tachycardia, then slows down – bradycardia), which also
is an indication for cesarean section.

Threat of uterine rupture

The great period of childbirth by a large child also poses a danger. AT
the process of passing the fetal head through the birth canal it
configurable, i.e. takes on a form convenient for overcoming
planes of the small pelvis (the bones of the skull “layered” on each other).
When the size of the head of the baby and the pelvis of the mother
an overstretching of the lower uterine segment occurs, which threatens
his break.

Fistula formation

Due to the long standing of the baby’s head in the same plane
pelvic soft tissues of the birth canal (neck and vagina) are compressed,
but besides that, the bladder is subject to pressure and
the urethra front and anus behind. it ведет к
impaired blood circulation in the tissues, ischemia, and then necrosis
(necrosis). Necrotic tissue is rejected after childbirth and
urinogenital and / or rectovaginal fistulas are formed.

Rupture of the symphysis joint

Difficult passage of the baby’s head can damage the pubic
articulation (torn ligament and divergence of the pubic bones), which
often, especially in severe cases, requires surgical
interventions after childbirth (see symphysitis during pregnancy).

Shoulder hanger

A high birth weight fetus can be complicated and difficult.
breeding shoulders, which is typical for children with diabetic
fetopathy (the size of the shoulder girdle is much larger
heads). AT данной ситуации оказывают специальные пособия, что
may result in fractures of the clavicle, humerus or cervical
of the spine.

Cefalohematoma or cerebral hemorrhage in the fetus

The development of such complications is due to anomalies of generic forces,
disorder of uteroplacental blood flow and subsequent
hypoxia of the fetus. When the configuration of the head is excessive
displacement of the cranial bones and a sharp compression of them, which causes
cerebral hemorrhage either under the periosteum.

ATедение родов

AT случае диагностики крупного плода, каким будет родоразрешение:
operative (cesarean section) or via the birth canal
(spontaneous labor) depends on many factors. Holding
planned caesarean section due to the following indications:

  • large sizes of fetuses in pregnant women under 18 and over 30 years;
  • a combination of pelvic presentation and a large child;
  • re-pregnancy with a large child;
  • anatomical narrow pelvis regardless of the shape and degree of narrowing and
    big weight of the child;
  • abnormal development of the uterus, myomatous nodes and large fetus;
  • indications requiring elimination of the period
    (cardiovascular pathology, high myopia) and large
    child;
  • heavy fetal weight and obstetric history (birth
    a dead child in the past, habitual miscarriage, sterility and
    the use of assisted reproductive technologies).

An emergency caesarean section is performed for any
complications during labor (weakness of contractions, threatening rupture
uterus, incorrect insertion of the head, etc.).

AT первые 2 часа после родов (ранний послеродовый период) высок
risk of developing hypotonic uterine bleeding that
обусловлено затяжными родами и чрезмерным растяжением uterus.

When drawing up a vaginal delivery plan,
consider:

  • childbirth should be monitored under the condition of the child
    and contractions;
  • in childbirth it is necessary to maintain a partograph (drawing up a schedule with
    taking into account the time of each period of labor, disclosure of uterine throat,
    contractions intensity);
  • in childbirth to re-measure the size of the pelvis;
  • adequate and timely pain relief and administration
    antispasmodics;
  • in the drinking season prophylactic administration of contraction
    means to prevent weakness of attempts;
  • early diagnosis of clinically narrow pelvis;
  • prevention of bleeding in the afterbirth and in the first 2
    hours after delivery.

Children born with a weight of 4 kg or more are in the high group.
risk of morbidity and mortality in early neonatal age
(up to 28 days of life), the development of birth injuries (cefalohematoma,
cerebral hemorrhage, fractures of the shoulder, clavicle), asphyxia, development
metabolic disorders and central nervous system pathologies
system.

ATопрос-ответ

Do you need hospitalization before delivery during pregnancy large
the fruit?

Yes, to all women diagnosed with large
baby, it is recommended to go to the hospital in advance, at 38 – 39 weeks.
ATрач проведет тщательное измерение размеров таза и живота, оценит
condition of the pregnant woman (presence of extragenital diseases and
pregnancy complications), cervical readiness (maturity) and
make a plan for the management of childbirth. And if there is evidence, the decision
the question of planned caesarean section and preparation for it.

How can you prevent the development of large fruit?

AT первую очередь необходимо с первых дней беременности
stick to a balanced diet. Food must contain
The amount of protein, fat and carbohydrates that a pregnant woman needs.
Expectant mother should abandon overeating, overuse
sweets, pastries, fatty and fried foods, and if it allows
state, to engage in special gymnastics for pregnant women and
avoid hypodynamia (frequent and prolonged lying and sitting).

I have the first pregnancy and a large fetus. I must
will make a cesarean section?

No, it is not necessary, especially during the first birth
young women. Most often, pregnancy and the birth of a large fetus
young healthy women are uneventful and end
safely.

Like this post? Please share to your friends:
Leave a Reply

;-) :| :x :twisted: :smile: :shock: :sad: :roll: :razz: :oops: :o :mrgreen: :lol: :idea: :grin: :evil: :cry: :cool: :arrow: :???: :?: :!: