srf
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27-year-old nondiabetic multiparous woman at 39 weeks gestation has had a previously uncomplicated pregnancy. Fundal height and estimates of fetal size have been at the upper limits of normal for several weeks. Today the fundus measures 44 cm from the pubis and you estimate on palpation that the fetus is large. Clinical pelvimetry is normal. <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
Which one of the following treatment plans is supported by objective clinical evidence?
Plan vaginal delivery, with personnel in the delivery room who are trained to assist with a difficult shoulder delivery should it occur
Order ultrasonography and perform a cesarean section if estimated fetal weight is 4000 g
Perform a cesarean section based on the clinical estimate of above-normal fetal size
Place the mother on a 500-calorie/day diet in order to slow fetal weight gain
Perform external podalic version to breech position and deliver vaginally, in order to decrease the likelihood of shoulder dystocia
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| mesh
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1.....
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| srf
Forum Guru
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1 is correct
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| AAAAA
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1
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| Jinx
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why not 2??
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| drhyd
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Though US is considered as an accurate way of detecting weight of the fetus, it can show an error about 300 to 500 g .
I think when u suspect macrosomia u should do pelvimetry and if from that u find bnormality u can go for section , but if pelvimetry is normal , go for expectanat mangaement waiting for vaginal delivery.
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| drhyd
Forum Senior
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One more thing , macrosomia = > 4000gms, so should we go section for all macrosomias? I dont think.
If there is any disproprtionality with pelvis and fetal head , then only we go for section, what u say guys
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| MAZI
Forum Elite
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i think 2
YOU SHOULD NOT LET THE MACROSOMIA BE ALONE
YES OR NO
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| cyra
Moderator
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Read up on this and the first option seems to be the way to go.
More on this here:
http://www.aafp.org/afp/20010115/302.html
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| frank100
Forum Guru
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(b) less risky and straight forward. with US you will know if thi si due to big pregnancy product or another problem
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| rajpharma
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hi
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| rajpharma
Forum Newbie
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1 is right ans
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| tolito
Forum Fanatic
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macrosomia on its own is not an indication for c/s
shoulder dysostocia on its own is not an indication for c/s.
clear cut indications are cephalopelvic disproportion, non-reassuring EFM (with a high false pos rate) and fetal malpresentation
the mx of shoulder dysostosia is as is listed in iption 1.
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| study_ing
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nice discussion 
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