Large fetus during pregnancy: causes, childbirth or caesarean section. Large fetus Large fetus: signs and diagnosis

A large fetus is a fetus that has a body weight of 4000 grams or more at the time of its birth. Often for a woman, even a baby weighing 3800 is already heavy, and it is not easy to give birth, however, the weight limit beyond which this diagnosis is made is 4000 ... If the weight of the newborn exceeds 5 kg, they talk about a giant fetus, there are known cases of the birth of babies whose body weight exceeded 7 kg .

Excessive weight of the baby in modern obstetrics is becoming a problem, because more and more babies are born with a lot of weight. At the same time, the large size of the child makes childbirth difficult, can cause complications, birth trauma, and can even be a reason for a caesarean section. Statistics show that every fifth child today is born weighing more than 4 kg.

Large fetus during pregnancy, causes

Why are women now increasingly giving birth to massive children and is it good? Improving human living conditions, easy availability of any food, changing eating habits and a large number of expectant mothers suffering from excess weight have led to this pathology.

We no longer give birth to 8-10 children, as we once did, we enter pregnancy as healthy as possible, and we take care of the child, trying to eat as well as possible and taking vitamins.

The slightest deviation in the condition of the child, the placenta is a reason to prescribe drugs that improve blood circulation in the placenta, to impose on a woman a regimen with restriction of motor activity. And the baby in the stomach is only engaged in gaining weight, it is laid in it, to grow and take the maximum for its growth that its mother can give it. And now she can give him literally everything.

Childbirth at an older age, which is so common now, in itself contributes to the birth of massive babies, affects the weight of the child and overmaturity, and hereditary predisposition.

This is facilitated by the prevalence of such a disease as diabetes mellitus. Once upon a time, not very long ago, literally in the last century, women were supposed to fast during the last weeks of pregnancy. It was precisely those foods that contributed to the weight gain of the child, such as fatty and sweet foods, wheat flour, butter, that were limited ... A modern pregnant woman does not even think about such a diet, and the arrow of the scales does not scare at all after childbirth excess weight can be dropped as well.

Women used to work until the day they gave birth. Today, starting from the 30th week, we get the opportunity to lie quietly on the couch, and eat, eat, eat ... And only when childbirth begins, the "big baby" becomes the body's response to these features of our life and pregnancy in modern conditions.

The reasons for the birth of large children may also lie in deviations in the development of the baby himself, his illnesses.

You are at risk if:

You are overweight
- the child has a tall and strong father
- you have diabetes
- you are going to have a second birth
- in your family, women usually give birth to children with a large weight
- if you are postponing this pregnancy

Large fetus, ultrasound diagnostics

A large fetus during pregnancy is diagnosed using ultrasound and calculations for the circumference of the abdomen and the height of the fundus of the mother's uterus. The trend towards deviation from the norm begins to be clearly observed only from the middle of pregnancy, before that all children develop approximately the same.

On ultrasound, the excess weight of the baby is diagnosed when the size of the circumference of the baby's head, tummy, the length of his thigh ceases to correspond to the gestational age, he overtakes him.

Large fetus and caesarean section

If you are told that the baby is overweight, a cesarean is not necessarily an inevitable outcome, often women are quite able to give birth even to a very large child through the birth canal. As a rule, this is a relative indication for caesarean section, and a caesarean section must be performed if other factors are present at the same time, such as, for example, a narrow pelvis or breech presentation.

The problem due to the large size of the child may arise during the birth itself, the clinical discrepancy between the fetal head and the mother's pelvis will lead to the need for surgery, and the massive body can simply get stuck with the shoulders, and this often ends with a fracture of the baby's collarbone.

The decision on how to conduct labor in the presence of a large fetus is made at 38 - 40 weeks of pregnancy, most likely, you will be hospitalized before the onset of labor, in advance.

How to make sure that the child is born with a normal body weight?

You should not perceive pregnancy as a disease, continue to be active, move. Eat right, do not lean on fatty and fried foods, avoid sweet and starchy foods, do not eat for two and make sure that only wholesome and healthy food is on your plate. If you have diabetes, despite the fact that during pregnancy you will definitely feel very good, strictly follow the dosages of drugs prescribed by your doctor, do not give up medicines.

And most importantly, stay positive. We are all very different, very individual. Perhaps everyone in your family gives birth to big babies? And you will give birth, you will cope on your own without any complications, because for you it will be the norm.

When a baby is born with a lot of weight, many are happy and consider this a sign of the health of mom and baby. Being pregnant, women, on the contrary, are afraid of this, since a large fetus is associated with many dangers, in particular, it can significantly complicate the course of childbirth.

In fact, you need golden mean: this is not a pathology and a very serious problem, but this fact cannot be taken lightly. This is just a risk factor, and if you fall into this group, you should find out all the nuances, pitfalls and features of delivery when the child is too large.

Many people mistakenly believe that a baby is born with a lot of weight due to the fact that the parents are not small, that is, the heredity factor is triggered. In fact, the features of the skeleton and the general type of figure, transmitted to a person from a mother or father, begin to appear at a much later age, but not immediately after birth.

There are special causes of a large fetus during pregnancy, and if you know about them in advance, you may not be at risk. Among them, the most common are:

maternal malnutrition: eating a large amount of carbohydrates (flour, confectionery, sweet), overweight up to obesity;
number of children: each subsequent child, according to statistics, is born larger than the previous one; so that all subsequent ones, most likely, can be complicated by the large size of the fetus;
sedentary lifestyle;
a woman has a metabolic disorder due to hypothyroidism or diabetes mellitus - accordingly, a large amount of glucose enters the blood of a child even in the womb, which leads to an increase in his body weight; so if at some point in pregnancy a large fetus is diagnosed at the same time, the mother is sent to be tested for sugar;
long-term use of certain medications: a version not confirmed by research, but doctors consider it as one of the causes of a large fetus, especially if during pregnancy the expectant mother took Actovegin and other drugs that improve uteroplacental blood flow;
a thickened placenta provides intensive intrauterine nutrition, which leads to the formation of a large fetus;
active intake of nutrients can occur due to the fact that the placenta is attached to the back wall of the uterus;
postmature pregnancy is also one of the causes of a large fetus, and it can also be diagnosed at 40 weeks if, in addition to a large weight, the child has a number of other signs of postmaturity: he has dry wrinkled skin, there is no original lubrication, long nails and hair are observed, too hard cranial bones, already closing fontanelles;
there is a theory that the fetus can be large if the mother took multivitamin complexes during pregnancy, but she does not find scientific confirmation.

Usually, if a doctor suspects a large fetus, he tries to establish the cause of this feature of pregnancy. Sometimes this allows you to identify diseases in the mother (, for example), or placenta previa, or put in order the nutrition and lifestyle of a woman even before childbirth. Sometimes there is enough time for the mass of the child to return to normal - then the course of childbirth is not complicated by anything. However, another question arises here: how to understand whether the fruit is large or not, is it worth sounding the alarm or not worrying about this?

We replenish vocabulary. The birth of a large child in obstetrics is called macrosomia.

signs

Doctors rarely make mistakes in such a diagnosis: there are certain signs of a large fetus that can be detected even during pregnancy. It should be noted right away that these include not only the weight of the baby: other factors matter here.

A large child is called a child whose birth will be difficult due to its size and weight. When a woman in labor, for example, even a 3.5-kilogram baby can be considered large.

Dimensions

In the course of research (ultrasound), all kinds of measurements of the fetus are made, as a result of which it is concluded whether it is large or not. With a full-term pregnancy at 40 weeks, these figures should not exceed the following norms.

Fetal parameters:

BDP (biparietal, i.e. between opposite bones of the crown, skull size) ≈ 93.9 mm;
LTE (fronto-parietal, i.e., the gap between the forehead and the crown, the size of the skull) ≈ 120 mm;
DB (this is the length of a small thigh) ≈ 75.8 mm;
SDGK (stands for the average diameter of the child's chest) ≈ 99.9 mm;
SDJ (as the average diameter of the abdomen is indicated) ≈ 108.2 mm;

Mother parameters:

weekly in the absence of edema and symptoms of preeclampsia ≈ 500 gr;
Coolant (this is the circumference of the abdomen) ≈ 100 cm;
VDM (designation for the height of the fundus of the uterus) ≈ 40 cm.

Having studied all these indicators, one can understand which fetus is considered large: if these indicators exceed the indicated values, the mother is at risk. In addition, doctors have an interesting formula by which you can calculate the approximate weight of a baby still in the womb: WDM is multiplied by coolant.

Symptoms

If the baby is overweight, it takes up a lot of space. Accordingly, the various organs of his mother, located nearby, are subjected to severe infringement and compression, experiencing an enormous load. Therefore, a pregnant woman in such cases may notice the following symptoms during the last 2-3 weeks before childbirth, which will indicate a large fetus:

frequent urination;
constipation;
fainting in the supine position, as the enlarged uterus puts strong pressure on the lower vein;
pain in the legs, ribs, spine, lower back due to the increased load on the musculoskeletal system;
development or exacerbation of varicose veins;
stretch marks on the abdomen;
increased tone of the uterus.

All these symptoms and signs need to be thought about already a few weeks before the birth and draw the attention of doctors to them. If for some reason you have to give birth ahead of schedule and you know this for sure, consult your doctor which fetus is considered large at week 38 (or at the time when your baby appears). As a rule, for such a calculation, 5-6 units must be subtracted from the above parameters (the size of the mother and child). For example, coolant should be ≈ 94-95 cm.

Keep in mind! Many mistakenly think too big belly in a pregnant woman, the first and most sure sign of a large fetus. This is not at all the case: it can also indicate polyhydramnios or multiple pregnancy. Even a small belly and a large fetus are possible.

What to do?

If 2-3 weeks before the birth, at the next examination, the gynecologist reported that you have a large fetus, you should not panic and immediately start talking about a caesarean section. You still have time to correct this risk factor, so consult a doctor who will tell you what to do in this situation. You will need:

undergo medical examinations to rule out multiple pregnancy and polyhydramnios;
conduct a glucose tolerance test and visit an endocrinologist to make sure that there is no diabetes mellitus;
find out the estimated weight of the fetus;
daily exercise therapy;
adjust nutrition: avoid sweet and starchy foods, i.e., easily digestible carbohydrates and refractory fats;
cancel or limit (in accordance with medical recommendations) the use of anabolic steroids.

If you follow these tips, by week 40 the situation may well improve and the doctor will be happy to inform you that the baby's weight is now within the normal range. In this case, you do not have to resort to: they are waiting for you natural childbirth with a successful outcome, without any complications associated with the large size of the child.

But what if it's too late or the correction failed? Then you will have to intensively prepare for surprises, and maybe for operative delivery.

The most helpful advice. Very often, young mothers, having heard that they have a large fetus, begin to worry so much and exhaust themselves with all kinds of diets that they only worsen the situation. As a result, they are on the delivery table ahead of schedule, and the baby is born restless and nervous. So the most important thing is not to panic, calm down and rely on the experience and professionalism of doctors in everything.

Possible Complications

Why, when a large fetus is detected during pregnancy, the question is often raised: caesarean or natural childbirth? It's all about the complications that the independent birth of a large child is fraught with. They can affect not only the health, but also the life of the baby. And the mother will have a very difficult time. Among the consequences, the following are considered the most dangerous.

narrow pelvis

This pathology is diagnosed if the baby has a large skull that does not correspond to the size of the pelvis in a woman (by the way, they can meet the standards) even with full opening of the cervix of the uterus. Strong, good contractions do not save the situation. If a woman in labor has a narrow pelvis and a large fetus, in most cases she is advised to do C-section.

Premature discharge of water

Due to its large size, the fetal head cannot press against the pelvic bones, and it occurs early. This is fraught with the fact that the loop of the umbilical cord and even the arm or leg of the baby may fall out, the uterine pharynx opens much more slowly, childbirth is delayed and exhausts the woman. Without amniotic fluid the child will last no more than 12 hours: then intrauterine infection can go on.

Anomalies of labor activity

A large fetus delays childbirth, which depletes the strength of the woman in labor. Diagnose, in which the intensity and frequency of contractions is significantly reduced. This can lead to intrauterine hypoxia. The way out of this situation is the stimulation of childbirth, which, however, is not the most in the best way affects the fetus.

breaks

Due to the large size of the fetal head, the lower uterine segment is overstretched, which leads to numerous ruptures in the uterus. Often the pubic joint is also damaged - the ligaments are torn, the pubic bones diverge. All this will have to be corrected after childbirth surgically.

Fistulas

If the fetal head, due to its large size, presses on the pelvic bones for too long, the neck, vagina, bladder, anus experience an enormous load. Among the consequences - circulatory disorders in soft tissues, ischemia, necrosis, in the future - rectovaginal fistulas.

Birth trauma in a child

Due to its large size, the fetus cannot pass through the birth canal on its own without injury. The bones of the skull (and with them the brain) are damaged, fractures of the shoulders, collarbone, and neck are diagnosed. The child may remain disabled for life or die. For the same reason, cerebral hemorrhage can occur.

Given all these complications, a woman, together with a doctor, needs to make the right decision on how to give birth: or by caesarean section. If the risk of complications is not so great, the size of the fetus is only slightly larger than the norm and they can be corrected, and the parameters of the pelvis of the woman in labor allow him to be born on his own, you should not insist on surgical intervention. But if the situation is critical and the doctors advise the CS, there is no need to resist: at stake is the life and health of the unborn baby.

Facts, facts. If doctors suggest that you have a large fetus, get ready to go to the hospital ahead of time: at 37-38 weeks of pregnancy.

Indications for caesarean section

Proper management of childbirth with a large fetus reduces the risk of complications by 80%. An experienced doctor who knows his business, even if it was decided to give birth naturally, will always keep a team of doctors and the necessary equipment for carrying out at the ready. Indeed, at any stage of labor, unforeseen circumstances may arise that threaten the life of the mother or child.

As a rule, a caesarean section for a large fetus is prescribed for the following indications:

age up to 18 and after 30 years;
breech presentation;
a large fetus detected on ultrasound and - in this case, a CS is necessarily prescribed, because such a baby cannot be born on its own;
delayed pregnancy;
anatomically narrow pelvis;
third births, if both previous ones were complicated by a very large fetus;
myomatous nodes and any other pathology of the uterus;
contraindications for attempts: problems with the heart and blood vessels, myopia;
poor obstetric history: if there was a stillbirth, prematurity, infertility, etc.

Polyhydramnios or moderate oligohydramnios with a large fetus are not considered absolute medical indications for caesarean section. In these cases, the baby is not in danger, and in the absence of other pathologies, he is quite capable of being born on his own.

Statistics. According to the latest data, 75% of cases with a large fetus end in a caesarean section.

Features of childbirth

Doctors know all the features of a caesarean section with a large fetus, which require them to have high professional skills and a certain amount of experience. Beginners do not trust such operations. Physicians take into account the following nuances:

caesarean section is carried out under monitor control;
a partogram is being drawn up - drawing up a schedule indicating the time of the period of childbirth, parameters of the opening of the pharynx, indicators of the intensity of contractions;
re-measurement of all dimensions is carried out;
anesthesia is done, antispasmodics are used;
reducing agents are used for preventive purposes;
a narrow pelvis should be diagnosed in a timely manner;
bleeding is prevented.

If doctors diagnosed a large fetus during pregnancy, do not be afraid of such news. You need to know all the risks associated with this fact and how to avoid them. A doctor's consultation is essential here.

Do not rush to insist on a caesarean section, fearing ruptures: for a baby, this will not be the best option for the development of events. Perhaps its size is not so colossal as to seriously harm you during childbirth. Listen to the recommendations of doctors - and complications can be avoided.

38 weeks of pregnancy is exactly 36 weeks of embryonic development of the crumbs. That is how much time it grows and develops inside the mother's womb. During this time, the baby has come a long way, completely repeating the entire evolution of mankind.

What he became and what is happening to him now, we will tell in this material.

Weight and height

The fetus at the 38th week of pregnancy is completely ready for independent life outside the mother's belly. R odes can happen at any moment, and you should not be afraid of this - they will not be considered premature, because the baby is full-term and matured.

What is his height and weight now, it is difficult to answer. The time of embryonic development has passed, when all the crumbs grew at about the same speed.

Now the size of the baby is purely individual and depends on two components: heredity and health.

If the mother and father of the crumbs have solid forms, then the crumbs will not be small. If the parents are petite, then the baby will be small. The weight of the fetus while it is in the mother's womb is difficult to determine, so the concept of "estimated weight" is used.

Assumes his program embedded in the ultrasound scanner. According to the size of individual parts of the child's body, she first gives a conclusion about the possible weight of his body. It should be taken into account that the error in this case is about 14% of the child's body weight up or down.

On average, babies are 38 obstetric week weigh more than 3 kilograms (3200-3600 gr). Height is 48-50cm. A large fetus at this time already weighs about 4 kilograms, and its growth can be 55-56 centimeters. If the pregnancy is difficult - with preeclampsia, Rhesus conflict, delay prenatal development, the weight may be small for a given period - within 2600-2800 gr.

Fetometry by ultrasound - norms

Ultrasound at this time is done to clarify the expected date of birth, to assess the degree of maturity of the baby's lungs and to study the characteristics of the placenta, which "works" at the limit of its capabilities - its inevitable aging has begun.

Fetometric indicators of the baby at this time are as follows:

biparental head size(BPR) on average - 93-94 mm;
fronto-occipital size(LZR) - 110-118 mm;
femur length- 74-75 mm;
leg bone length- 64-65 mm;
tummy circumference- 330-336 mm;
Head circumference- 330-333 mm
chest diameter- 101 mm.

There are no strict norms at 37-38 weeks, because the physique is also an individual trait.

In some babies, the length of the thigh will be more than normal only because the baby has inherited long legs, while in another the head will be less than normal, because everyone in the family has small neat heads, so the data presented above is just an average.

Appearance

At 38 weeks pregnant, the baby looks like a fully formed small man. This is how mom will see him very soon, nothing else will change in his appearance.

The skin of the crumbs has acquired a delicate pink shade, they are no longer red and wrinkled. The wrinkles were smoothed out due to the fact that during the third trimester the baby accumulated a large amount of subcutaneous fat, for the same reason the skin color also changed.

Blood vessels with the appearance of a "fat layer" have become further from the surface of the skin, the redness and network of blood vessels are now almost invisible.

Some palms and heels remained wrinkled, but they will remain so after childbirth for at least another 1-2 months. Until recently, the entire body of the child and his face were covered with a thick white primordial grease. She protected skin, thin as parchment, from the negative effects of various factors. Now there is no lubrication. She remained in small quantities only where there is a possibility of friction - in the folds of the skin in the groin, under the knees, in the fold of the upper limbs and quite a bit in the neck crease.

98% of boys had their testicles descended into the scrotum by 38 weeks., this fact can be certified by a doctor ultrasound diagnostics. For the rest, the testicles may descend before 40 weeks or after childbirth.

In girls at 38 weeks of gestation, the small labia are covered with large, this is the main feature proper development external genitalia in female fetuses.

Both the labia and the scrotum can be slightly enlarged, because right now the mother's body produces a large amount of estrogens - hormones that help the mother's body prepare for childbirth. A side effect of these hormones is a slight swelling of the genitals and mammary glands of the fetus.

The amount of hair on the head can be different. There are kids with solid and funny hair, and there are bald crumbs, this is a genetic feature. But all the babies this week have quite long and sharp fingernails, and they continue to grow.

Lanugo - a small fluff that covered the entire body of the baby, completely disappears at 38 weeks. The skin becomes smooth and tender.

The facial skeleton and facial muscles are fully formed. On a three-dimensional ultrasound image, you can clearly see which parent the child looks like, and if you do a four-dimensional ultrasound, you can enjoy the variety of grimaces and facial movements that the baby now “owns” perfectly.

Development of internal organs

All organs of the baby are formed and are already working. The only exceptions are the lungs, which will begin to work immediately after birth. An important process is now being completed in them - the accumulation of a special substance of surfactant, which will enable the lungs to turn around normally at the first breath of the baby.

The cardiovascular system of the crumbs works smoothly - heart rate (HR) at this period averages 157 beats per minute(permissible fluctuations - from 146 to 168 beats per minute).

In boys, the heart beats a little slower than in girls, although this fact, confirmed by obstetricians with rich experience, is not recognized by official medicine. The heartbeat is well heard on ultrasound, CTG, and even at home using a conventional phonendoscope.

The digestive organs of the baby are coordinated with each other. He swallows amniotic fluid, the stomach digests them, burps the excess (this is how hiccups occur), the rest goes into the intestine, which has already accumulated and continues to accumulate the original black-green meconium stool. It is meconium that will leave the intestines after birth, thereby starting the work of the digestive organs in a new environment for the baby.

The kidneys, liver, pancreas of the child and other organs regularly perform their functions.

Nervous system

Nervous system so far imperfect. And so it will be for a long time after the birth. In the brain every day there are more and more neural connections, and this process will continue.

The baby moves quite "meaningfully", all his movements at the level of motor skills are controlled by the brain. Until a few months ago, most of the movements were chaotic. In the arsenal of the baby there are several dozen reflex movements necessary for a person, even such a small one, to survive.

The baby is fluent in sucking, swallowing and grasping reflexes. He feels a lot and subconsciously understands: this can explain the emotional response that babies show at 38 weeks of gestation.

They can experience fear, joy, they can worry and be nervous with their mother, if she is worried. They recognize native voices from a mass of other sounds.

sense organs

A child at 38 weeks of gestation, while not sleeping, is actively exploring the world that surrounds him in the womb. He opens and closes his eyes. Vision is formed, but its functions are still insufficient, to see in the normal sense of the word, the child will begin a few weeks after his birth.

Now he only distinguishes between blurry contours and light spots, distinguishes light from darkness well, and already knows exactly when it is day and when it is night outside of his mother's belly.

The baby's hearing works great. He listens to the voices of mom and dad, mother's heartbeat, intestinal motility, buzzing blood flow through the vessels. Extraneous sounds, especially sharp and sudden ones, can frighten the baby, for example, claps, calls, loud barking of a dog. In response to familiar, and therefore “safe” sounds in the understanding of the crumbs, the baby calms down, unfamiliar ones can cause him an increased motor activity or fading in anticipation - it depends on the nature of the baby.

Baby at 38 weeks distinguishes taste well, taste buds work and give him all the necessary information about the taste amniotic fluid, which varies depending on the food that the mother consumes.

The baby’s sense of touch is well developed, in the womb he studied a lot by touch, and after birth, tactile contact with his mother will be the best “soothing” for the baby for a long time to come.

perturbations

The number of normal movements at week 38 may decrease, because the baby is already so large that it occupies the entire uterine cavity, there is no room for maneuvers and movements. This does not mean that a woman should stop monitoring the number of movements. As before, you need to mark them within 12 hours. During this time, the mother must count at least 10 episodes of activity..

If it seems that the baby is moving a little, he has calmed down for more than 3-4 hours, it makes sense to inform the doctor about this. Active movements, especially at night, if they deliver to a woman pain if they are sharp, chaotic, they can also be an unfavorable sign possible hypoxia fetus due to aging of the placenta, due to entanglement with the umbilical cord.

If the baby moves a lot or, conversely, moves a little, you should do a CTG, an ultrasound scan and, together with the doctor, decide what to do next.

presentation

At this time, the vast majority of babies take the most suitable position for birth - the head. With it, the fetal head is already tightly pressed to the exit from the small pelvis, practically rests on it, this causes unusual sensations in the mother - she has a pull on her lower abdomen, there may be various “tingling” in the lower abdomen, often there is an urge to urinate.

If the baby strongly presses the head on the nerve endings, the woman may feel as if she is being “shocked”.

If the baby is in a breech presentation this week or is located across - in a transverse presentation, then there is practically no chance of him turning over to the head position due to the fact that there is very little space left in the uterus for movements, and the amount of amniotic fluid has significantly decreased .

At 38 weeks, an ultrasound is done, and, if the abnormal location is confirmed, a planned caesarean section is scheduled, which is carried out at 38-39 weeks, or a week later. In addition to the risk of injury during childbirth, if the child lies incorrectly, the presentation does not create any other threat to the baby.

Possible problems

What happens to the baby at the 38th week of pregnancy can be told by cardiotocography, which is sometimes prescribed before childbirth at this particular time. If, according to the results of the study, the baby has tachycardia or bradycardia, if he often hiccups, hypoxia is not excluded, the woman will be offered labor induction or caesarean section as soon as possible.

If the expectant mother is already in the hospital, CTG will be done there, if she is at home, the procedure is carried out in a consultation at the place of residence.

At this time, independent childbirth can begin. In front of them, babies usually calm down and reduce their activity in a few days. Childbirth can begin with contractions, with leakage or discharge of amniotic fluid, with the exit of the mucous plug from the cervical canal.

With the appearance of atypical discharge at this time, increasing pain in the lower back in the lower abdomen, the expectant mother needs to call an ambulance or go to the hospital on your own. According to statistics, about 35% of babies are not born on the due date (the estimated date of birth indicated on the exchange card), namely at 38 weeks of gestation. This is completely normal.

You can read more about pregnancy at week 38 from the following video.

What's happening
Fetal development
discharge and pain

There is an opinion among the population that the large weight of the fetus speaks of health and strength, but only mothers who have given birth to "heroes" and doctors know what difficulties they have to face during childbirth and after the birth of a child. If you believe the statistics, then the birth of a large child is noted in 5 - 10% of all births.

Definition of concepts

A large fetus or macrosomia is said to be when its fetometric indicators of intrauterine development significantly exceed the established norm for a particular gestational age, or the weight of a newborn is 4 kg or more. In addition to the weight of the child, his height is also taken into account, so, in normal baby growth is in the range of 48 - 54 cm, while the length of a fetus with a large weight is 54 - 56 cm, and in some cases reaches 70 cm.

If the weight of the child at birth is 5 kg or more, then they speak of a giant fetus. The birth of giant children is less common than large ones, and has a ratio of 1/3000 births.

Causes

Why a child is born large is explained by many reasons, which can be due to both the characteristics of the woman's body and the individual characteristics of the baby developing in the uterus. These factors include:

genetic predisposition

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

Increasing the duration of pregnancy

Normally, pregnancy lasts 38 - 41 weeks (see). If the gestational age exceeds the upper limit of the norm, they talk about over-pregnancy, which can be true and false. With true overwearing, a child is born with obvious signs of overwearing: dry, without original lubrication of the skin, its wrinkling, waters have a greenish or grayish tint, and their number is reduced. Such phenomena are explained by the aging of the placenta, the formation of multiple calcifications in it, and a decrease in its functions. The lack of oxygen and nutrients leads to the development of placental insufficiency, hypoxia and even fetal hypotrophy.

Diabetes in a woman

The birth of a large baby (or on ultrasound more than the gestational age) may be due to the presence of diabetes in the mother or its development during gestation (gestational diabetes). Children are born with a number of characteristic signs, which is called diabetic fetopathy. The large weight of the fetus is the result of hormonal storms and constant jumps in the level of glucose in the woman's blood. A characteristic sign of diabetic fetopathy is excessive weight gain in the baby after 20 weeks of pregnancy against the background of developing polyhydramnios. Accordingly, the child, although born large, is initially unhealthy. Pregnant women with diabetes are hospitalized no later than 32 weeks, examined and decide on the timing and methods of delivery.

Rh-conflict pregnancy

One of the reasons that determine the size of the fetus over the term is. This complication of gestation occurs when a child with a positive Rh factor is born by a woman who has a negative Rh factor. As a result, the unborn child develops a hemolytic disease, which is characterized by anemia and jaundice, and in extremely severe forms, swelling joins them, which is called the edematous form hemolytic disease. At the same time, in the cavities of the fetus (stomach, chest) fluid accumulates, and the liver and spleen increase significantly in size. Massive edema and hepatosplenomegaly determine the large weight of the child.

Features of the placenta

The structural and functional features of the placenta can also provoke the formation of a large baby (see also). Often, at the birth of a child with a large body weight, a placenta of large size and thickness (5 cm or more) is noted. A thick and massive placenta promotes an intensive exchange of nutrients and microelements, which accelerates the development of the fetus. In addition to an increase in the volume of circulating blood and intensive blood supply to the child, there are bursts of placental hormones, which indirectly affect the metabolism in the mother's body and enhance the growth and development of the baby.

Subsequent pregnancies ending in childbirth

A directly proportional relationship was noted between the number of births and the body weight of children born. After the second, third, and so on, a large fetus is formed, which is about 30% larger than the size and weight of the firstborn. Doctors explain this fact in two ways.

First, it matters psychological factor, a woman, bearing a second / third child, is familiar with the processes of pregnancy and childbirth, is more balanced and calm.
Secondly, the large size of the baby during subsequent pregnancies is due the best conditions intrauterine nutrition due to the developed circulatory network in the uterine wall.
Also, the conditions for intrauterine growth and development of the second child are much better due to the greater extensibility of the uterus and slight resistance of the abdominal muscles.

The nature of the nutrition of a pregnant woman

An important role in the increase in the weight of the child is played by the nutrition and lifestyle of the woman, especially after the 20th week of pregnancy (see). Hypodynamia, a growing belly, a passion for high-calorie foods (consumption of muffins, sweets, pasta) leads not only to the accumulation of fatty tissue in the expectant mother, but also provokes macrosomia in the fetus (see).

Obesity

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

Taking medications

Uncontrolled consumption of certain drugs by a pregnant woman, which improve uteroplacental circulation and activate anabolic processes (for example, gestagens,) also contribute to weight gain.

Other factors

The age of a woman (under 20 or over 34 years old), the presence of inflammatory processes in the organs of the reproductive system, can also affect the size.

Large fruit: signs and diagnosis

If a woman has a large belly during pregnancy, this is not necessarily evidence of a large child. Multiple pregnancy should be excluded and (many pregnant women neglect the passage of ultrasound during such an important period of life).

By 38 weeks of pregnancy, and sometimes earlier, clinical manifestations large fetal sizes are objective data obtained during a visit to the obstetrician. At each appearance in the antenatal clinic, a pregnant woman is measured body weight, an increase of 500 grams. weekly, against the background of absent edema and other signs of gestosis, makes the doctor suspect a large weight in the baby.

In the case of a large fetus during pregnancy, the signs are determined by the size of the woman's abdomen (circumference and height of the fundus of the uterus), evidence of this is the exceeding dimensions: The circumference of the abdomen is more than 100 cm, and the height of the fundus of the uterus is more than 40.

The estimated weight of the fetus is calculated by the formula: coolant is multiplied by VDM.

Since a baby with a large weight in utero takes up more space, the internal organs of a woman are subjected to greater compression and infringement and experience a significant load. As a result, the pregnant woman notes frequent urination, heartburn (reflux of gastric contents into the esophagus), constipation and shortness of breath. A large uterus presses on the inferior vena cava, which can provoke fainting in a horizontal position lying on your back. The load on the musculoskeletal system increases, which is manifested by pain in the legs, lower back, spine and ribs. Possible occurrence or worsening of the course of varicose veins of the legs. Also, there is a high probability of stretch marks on the abdomen and an increase in the tone of the uterus.

Ultrasound is of great importance in the diagnosis of a large fetus, with a thorough measurement of the fetal data of the fetus and the determination of its estimated weight. The circumference of the head and abdomen, the length of the femur and humerus are measured. A large head and a significant size of the abdomen, an increase in the liver and spleen, the identification of fluid in the body cavities indicates an edematous form of hemolytic disease.

The course of pregnancy

Pregnancy in women with a large fetus proceeds, as a rule, without complications. All the described complications (fainting, problems with the digestive tract and shortness of breath) develop by 38-40 weeks of pregnancy with a large fetus. There is a high probability of developing placental insufficiency and progressive hypoxia as a result of a discrepancy between the uteroplacental blood flow and the rapidly increasing weight of the child. Pregnancy features include:

a thorough examination to exclude polyhydramnios and;
exclude diabetes mellitus - conducting and consulting an endocrinologist;
calculation according to ultrasound data and the size of the pregnant belly of the estimated weight of the fetus;
physiotherapy;
diet correction (exclude easily digestible carbohydrates and refractory fats);
cancellation or restriction of taking drugs - anabolics.

The course of childbirth

“How to give birth if the fetus is large?” expectant mothers ask. The answer is not the course of childbirth, which, with large sizes, have their own characteristics. Spontaneous childbirth of a child of considerable size is 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) of the uterine os, it does not advance, which is called a mismatch in the size of the head to the woman's pelvis. It is characteristic that the size of the maternal pelvis may be within the normal range, but still, childbirth is difficult even with good and strong contractions. If there is also an anatomical narrowing of the pelvis (the size of the pelvis is shortened by 1-1.5 cm or more), the question of a caesarean section is raised.

Untimely outpouring of waters

Early discharge of water (before the opening of the pharynx by 8 cm) is due to the high standing of the baby's head, so due to its large size it cannot press against the entrance to the small pelvis and move forward, and there is no separation of water into the anterior (fetal bladder) and posterior ones. Early outflow of water is dangerous by prolapse of the umbilical cord or small parts of the child (leg, handle). In addition, this complication slows down the process of opening the uterine os, which lengthens the 1st period of labor and exhausts the woman in labor. If the anhydrous interval continues for 12 hours or more, the risk of the uterus is also high. If the umbilical cord or part of the fetus falls out, immediate operative delivery is indicated.

Anomalies of tribal forces

Childbirth with a fetus of large size is often complicated by anomalies of labor activity. A protracted course of childbirth leads to a decrease in the intensity and frequency of contractions (weakness of the birth forces develops, both primary and secondary). The child begins to suffer, intrauterine hypoxia increases (at first it becomes more frequent - tachycardia, then it slows down - bradycardia), which is also an indication for caesarean section.

Threat of uterine rupture

The straining period of childbirth with a large child is also fraught with danger. In the process of passing the fetal head through the birth canal, it is configured, that is, it acquires a shape that is convenient for overcoming the planes of the small pelvis (the bones of the skull "layer" on top of each other). With a disproportionate size of the baby's head and the mother's pelvis, the lower uterine segment is overstretched, which threatens to rupture it.

Fistula formation

Due to the prolonged standing of the baby's head in the same plane of the pelvis soft tissues the birth canal (cervix and vagina) are compressed, but in addition to them, the bladder and urethra are compressed in front and the anus in the back. This leads to impaired blood circulation in the tissues, ischemia, and then necrosis (necrosis). Necrotic tissues are shed after childbirth and genitourinary and/or rectovaginal fistulas are formed.

Rupture of the pubic joint

Difficult passage of the baby's head can damage the pubic articulation (rupture of the ligaments and divergence of the pubic bones), which often, especially in severe cases, requires surgical intervention after childbirth (see).

Shoulder dystocia

Childbirth with a fetus with a large weight can be complicated by difficult removal of the shoulders, which is typical for children with diabetic fetopathy (the size of the shoulder girdle is much more sizes heads). In this situation, special benefits are provided, which can result in fractures of the clavicle, humerus or cervical spine.

Cephalohematoma or cerebral hemorrhage in the fetus

The development of such complications is due to anomalies of the birth forces, disorder and subsequent. When the head is configured, there is an excessive displacement of the cranial bones and a sharp compression of them, which causes hemorrhage in the brain or under the periosteum.

Birth management

In the case of the diagnosis of a large fetus, what will be the delivery: operative (caesarean section) or through the natural birth canal (spontaneous birth) depends on many factors. Carrying out the planned:

large size of the fetus in women under 18 and over 30 years of age;
combination of breech presentation and a large child;
prolongation of pregnancy with a large child;
anatomical narrow pelvis, regardless of the shape and degree of narrowing, and the large weight of the child;
anomalies in the development of the uterus, myomatous nodes and a large fetus;
indications requiring the exclusion of the straining period (cardiovascular pathology, high myopia) and a large child;
large fetal weight and aggravated obstetric history (birth of a dead child in the past, and the use of assisted reproductive technologies).

A caesarean section for emergency indications is performed for any complication during childbirth (threatening uterine rupture, improper insertion of the head, etc.).

In the first 2 hours after childbirth (early postpartum period), there is a high risk of developing hypotonic uterine bleeding, which is due to prolonged labor and excessive uterine distension.

When drawing up a plan for childbirth through the birth canal, take into account:

childbirth should be carried out under the monitoring control of the child's condition and;
in childbirth, it is obligatory to maintain a partogram (drawing up a schedule taking into account the time of each period of childbirth, disclosure of the uterine os, intensity of contractions);
during childbirth, re-measure the size of the pelvis;
adequate and timely anesthesia and the introduction of antispasmodics;
in the pushing period, prophylactic administration of reducing agents in order to prevent weakness of attempts;
early diagnosis of a clinically narrow pelvis;
prevention of bleeding in the afterbirth period and in the first 2 hours after childbirth.

Children born with a weight of 4 kg or more are at high risk for morbidity and mortality at an early neonatal age (up to 28 days of life), the development of birth injuries (cephalohematoma, cerebral hemorrhage, fractures of the shoulder, collarbone), the development of metabolic disorders and pathology of the central nervous system.

Question answer

Is hospitalization necessary before delivery when pregnant with a large fetus?

Yes, all women diagnosed with a large baby are advised to go to the hospital in advance, at 38-39 weeks. The doctor will carefully measure the size of the pelvis and abdomen, assess the condition of the pregnant woman (the presence of extragenital diseases and complications of pregnancy), the readiness of the cervix (maturity) and draw up a plan for the management of childbirth. And if there is evidence, the decision on the issue of a planned caesarean section and preparation for it.

How can the development of a large fetus be prevented?

First of all, it is necessary to adhere to a balanced diet from the first days of pregnancy. Food should contain the necessary amount for a pregnant woman of proteins, fats and carbohydrates. Future mom should give up overeating, excessive passion for sweets, pastries, fatty and fried foods, and if the condition allows, do special exercises for pregnant women and avoid hypodynamia (frequent and prolonged lying and sitting).

This is my first pregnancy and I have a large fetus. Will I have to have a caesarean section?

No, it is not necessary at all, especially in the first childbirth of young women. Most often, pregnancy and the birth of a large fetus in young healthy women proceed without complications and end happily.