Macrosomia
Roya Sohaey, MD
DIFFERENTIAL DIAGNOSIS
Common
Idiopathic Macrosomia
Diabetes
Less Common
Hydrops
Rare but Important
Beckwith-Wiedemann Syndrome
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Large for gestational age fetus
↑ Estimated fetal weight (EFW)
> 90th or 95th percentile
Birth weight > 4,000-4,500 g
AC alone can predict macrosomia
37% risk of macrosomia if AC > 37 cm
< 1% risk of macrosomia if AC < 35 cm
AC often 1st measurement to ↑
↑ Glycogen stores in liver
Truncal obesity
Prevalence
16-18% in diabetics
6-8% in non-diabetics
Helpful Clues for Common Diagnoses
Idiopathic Macrosomia
No fetal anomalies
Hereditary factors (↑ risk if mom is large)
1/3 with polyhydramnios
Diabetes
Polyhydramnios common
Associated anomalies
Caudal dysplasia/regression
Open neural tube defect
Cardiac anomalies (5x ↑ risk)
Polydactyly
GU/GI anomalies
Single umbilical artery
Helpful Clues for Less Common Diagnoses
Hydrops
Immune and nonimmune causes
Excessive body fluid
large fetus
Anasarca ± cystic hygroma
Pleural effusion
Ascites
Helpful Clues for Rare Diagnoses
Beckwith-Wiedemann Syndrome
Signs/symptoms
Macroglossia
Enlarged internal organs (especially kidneys)
Hemihypertrophy
Omphalocele
Prognosis
20% infant mortality
7-10% tumor risk (Wilms tumor most common)
Other Essential Information
Fetal complications of macrosomia
Shoulder dystocia (10%)
Asphyxia
Hypoglycemia, hypocalcemia
Macrosomia associated with polyhydramnios
Image Gallery
 Axial ultrasound of the fetal abdomen shows increased truncal subcutaneous fat
 . The abdominal circumference measurement was 5 wks greater than the other fetal biometric measurements. Stay updated, free articles. Join our Telegram channel
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