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Concept
Large for gestational age
Summary
Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term that describes excessive birth weight, but refers to an absolute measurement, regardless of gestational age. Typically the threshold for diagnosing macrosomia is a body weight between , or more, measured at birth, but there are difficulties reaching a universal agreement of this definition.
Evaluating an infant for macrosomia or LGA can help identify risks associated with their birth, including labor complications of both the parent and the child, potential long-term health complications of the child, and infant mortality.
Fetal macrosomia and LGA often do not present with noticeable patient symptoms. Important signs include large fundal height (uterus size) and excessive amniotic fluid (polyhydramnios). Fundal height can be measured from the top of the uterus to the pubic bone and indicates that the newborn is likely large in volume. Excessive amniotic fluid indicates that the fetus’ urine output is larger than expected, indicating a larger baby than normal; some symptoms of excessive amniotic fluid include
shortness of breath
swelling of lower extremities & abdominal wall
uterine discomfort or contractions
fetal malposition, such as breech presentation.
LGA or macrosomic births can lead to complications for both the mother and the infant.
Common risks in LGA babies include shoulder dystocia, hypoglycemia, brachial plexus injuries, metatarsus adductus, hip subluxation and talipes calcaneovalgus, due to intrauterine deformation.
Shoulder dystocia occurs when the infant's shoulder becomes impacted on the mother's pubic symphysis during birth. Newborns with shoulder dystocia are at risk of temporary or permanent nerve damage to the baby's arm, or other injuries such as fracture. Both increased birth weight and diabetes in the gestational parent are independent risk factors seen to increase risk of shoulder dystocia.
Official source
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