Extreme fetal macrosomia at 42 gestational weeks: a case report and literature review

Abstract

Objectives: Fetal macrosomia is a term to describe excessive fetal birth weight. Fetal macrosomia is strongly associated with adverse obstetrical outcome.

Case presentation: We report a rare case of excessive neonatal weight in a medically unsupervised pregnancy and give a literature review on this significant subject. A 38 year-old woman (Gravida 8 Para 7) presented herself at 42 2/7 weeks of gestation at the labor ward. The pregnancy had not been supervised medically. Labor induction was initiated. Due to failure to progress and suspicion of a disproportion of the fetal head and maternal pelvis an urgent caesarean section was performed. A morbidly macrosomic male infant was delivered (birth weight: 6,760 g [>99. percentile], length: 60 cm [>99. percentile]).

Conclusions: The morbidity for infants and women increases with a birth weight exceeding 4,500 g. Gestational diabetes mellitus, a high pre-pregnancy body mass index and excessive gestational weight gain have been independently associated as risk factors. The increase in pregnancies complicated by maternal obesity and gestational diabetes emphasizes the necessity of evidence-based clinical interventions to prevent or reduce these diseases. If prenatal care is not frequented by mothers-to-be there are no options open for obstetricians to detect fetal macrosomia and to intervene.

Keywords: fetal macrosomia; gestational diabetes mellitus; maternal obesity; unsupervised pregnancy.

Figure 1:

Neonatal echocardiography.

Figure 2:

Neonatal abdominal ultrasound showing excessive abdominal fat.