Large fetus during pregnancy. How does labor proceed when a large fetus is born?

In the times of Rus', according to an unspoken rule, a pregnant woman was expected to give birth to a hero. The large size of the baby spoke of his good health and future strength. This belief is based on ancient legends and epics about mighty knights - the most worthy representatives of the Slavic people. And only the mothers of modern strong babies can tell what problems they had to face during and after the birth of their “non-standard” children. Statistics show that large babies are born in 5–10% of all births.

Macrosomia is a medical term for a condition in which the main characteristics of fetal growth in the womb exceed accepted standards for each trimester of pregnancy or the weight of the fetus is more than 4 kg. When determining the weight of a baby, be sure to take into account the indicators of his growth: the length of a medium-sized fetus varies from 48 to 54 cm, while the growth of a fetus with a large weight reaches the limits of 55 - 56 cm, and sometimes 65 - 70 cm. When the child’s weight is 5 kg or more, the fruit is considered gigantic.

Causes of a large fetus during pregnancy

There are many explanations for why babies are born too big, and it depends both on the characteristics of the mother’s body and on the specific characteristics of the child himself.

Among the causes of macrosomia, we will highlight and consider the following:

genetic factor. Heredity is the most obvious reason for the birth of a large child. Physically developed, tall parents very often give birth to real heroes;
post-term pregnancy. The period from 38 to 41 weeks is optimal for the full intrauterine development of the fetus. If the duration of gestation for some reason exceeds the norm, the pregnancy is regarded as post-term. As a result, an overripe baby is born, who continued to develop in the womb and reached a greater degree of maturity than expected;
diabetes mellitus in a pregnant woman. Non-standard parameters of the fetus may be the result of a serious illness of its mother or the appearance of so-called gestational diabetes after conception. In this case, the baby grows by leaps and bounds due to hormonal changes and regular changes in the mother’s blood sugar concentration. A clear sign of the impact of maternal diabetes on the fetus is excessive weight gain after 20 weeks with concomitant polyhydramnios. The paradox is that, despite the child’s large physique, he cannot be called healthy. Expectant mothers with diabetes are admitted to the hospital at 32 weeks to undergo a full examination and decide how the woman will give birth;

pregnancy with Rh conflict. If a woman with a Rh factor with a “+” sign carries a child with a negative Rh factor, the pregnancy is complicated by Rh conflict. On this basis, the condition of the fetus is complicated by hemolytic disease, expressed by signs of anemia and jaundice. When complications occur, these pathologies are accompanied by swelling, in which fluid accumulates in the baby’s body (in the abdominal cavity, chest), while his liver and spleen become severely swollen. The development of these pathologies is responsible for the large body weight of the fetus;
specificity of the development of placental tissue. Intensive fetal growth can be determined by the characteristics of the placenta. Often when a large baby is born, the placenta is large and dense (at least 5 cm thick). It, in all likelihood, accelerates the metabolism of other useful elements, as a result of which the active development of the fetus begins. In addition, sometimes there is an increase in the level of placental hormones, which also stimulates the growth and development of the child in the womb;
previous pregnancies that ended in childbirth. It is noted that after the second, third and subsequent births, children are born increasingly larger. The third or fourth baby in a family is usually 30% larger than the first-born. Doctors explain this fact in different ways. Some are sure that a woman who is carrying a child not for the first time is well aware of all the intricacies of pregnancy and childbirth, therefore she feels calm and confident, which has a beneficial effect on the baby. Other doctors believe that subsequent pregnancies are more successful due to better blood circulation in the walls of the uterus, which is only possible after 2 or 3 births. In addition, the baby has all the conditions for intensive growth - after several previous pregnancies, the uterus stretches well, and the abdominal muscles do not provide serious resistance to it;

nutrition expectant mother. The diet and lifestyle of the expectant mother, especially after 20 weeks of pregnancy, have a significant impact on the rate of fetal growth. Lack of active pastime, abuse of rich and unhealthy foods (baked goods, sweets, pasta, fried meat) provokes an increase in the percentage of fat in the body. female body and contributes to the development of macrosomia in the child;

obesity. This condition is characterized by a disorder of fat metabolism in a woman’s body, which causes a metabolic disorder in the child. In addition, maternal obesity threatens the fetus with intrauterine damage to the liver and pancreas. This promotes accelerated growth of the child in the womb;
taking medications. There are some medications (for example, Actovegin) that stimulate blood circulation in the uterus and placenta. If a pregnant woman is forced to take such drugs, their effect may cause an increase in fetal weight;
other factors. Age of the expectant mother (less than 20 and more than 35 years), inflammatory chronic diseases of the reproductive system, disorders menstrual cycle can also affect the development of macrosomia in a child.

Signs of a large fetus during pregnancy: diagnostic methods

An expectant mother with a big belly is not necessarily carrying a large baby. First of all, the doctor will conduct the necessary tests to rule out multiple pregnancy and polyhydramnios.

By 38 weeks of pregnancy or slightly earlier, an obstetrician may detect clinical signs of a large baby in a woman. At each visit to the antenatal clinic, the doctor measures and records the weight of the expectant mother. If there is a weekly weight gain of 500 g, and there are no swelling or other symptoms of late toxicosis, there is every reason to talk about a large fetus.

The development of a child with high weight during pregnancy is determined by studying the parameters of the expectant mother’s abdomen, which include the circumference and height of the uterine fundus. The heroic inclinations of the baby are evidenced by:

abdominal circumference more than 100 cm;
The height of the uterine fundus is more than 40 cm.

The approximate weight of the child is calculated by multiplying the abdominal circumference by the height of the uterine fundus.

A large fetus in the womb takes up quite a lot of space, so all the internal organs of its mother are in a cramped and restrained state. In this regard, the pregnant woman is tormented by frequent urges to empty the bladder, constipation, shortness of breath, heartburn and nausea. Moreover, the greatly enlarged uterus compresses the inferior vena cava, which leads to fainting when the woman lies on her back on a flat surface. We also note that during pregnancy with a large fetus, bones and muscles experience disproportionate stress - outwardly this is expressed by painful sensations in the lumbar region, spine, ribs and legs. In some cases, varicose veins develop or become complicated lower limbs, a network of large stretch marks appears on the abdomen. Often, during pregnancy with a large fetus, the uterus becomes toned.

Ultrasound remains the most reliable diagnostic method for identifying a child with high body weight. During the procedure, the doctor can measure the circumference of the fetus's head and abdomen, and the length of its femur and humerus. A large head, large belly, enlarged liver and spleen, as well as the presence of fluid in the body cavities indicate that the baby suffers from an edematous form of hemolytic disease.

The course of pregnancy with a large fetus

Even if the baby’s parameters exceed standard indicators, in most cases pregnancy develops without complications. The future mother's well-being due to fainting, shortness of breath or digestive problems is expected only at 38 - 40 weeks. Sometimes progressive hypoxia and dysfunction of the placenta develop due to the rapid growth of the child against the background of “lagging” uteroplacental blood flow.

A large fetus during pregnancy is the object of close attention from doctors. Management of such a patient involves:

Mandatory examination for the presence of polyhydramnios or multiple pregnancies.
Testing for glucose tolerance and examination by an endocrinologist to rule out the presence of diabetes.
Ultrasound examination and regular measurements of the abdomen to calculate fetal weight.
Health-improving gymnastics.
A special diet (based on reducing easily digestible carbohydrates and saturated fats to a minimum).
Complete abolition or limitation of taking medications that increase metabolism.

Large fetus during pregnancy: what will the birth be like?

A woman carrying a large baby under her heart is most worried about how the birth will go. These experiences, unfortunately, cannot be called groundless. The natural birth of a baby with a large body weight may be associated with some complications and obstacles. Let's consider the main aggravating factors:

narrow pelvis according to a medical report. The complication is due to the fact that a fetus that is too large will not move forward, even if the uterus is fully dilated. In some cases, a woman with a normal sized pelvis still has a difficult labor with full contractions because the baby's head is too large;
early breaking of water. During pregnancy with a large fetus, amniotic fluid may leak earlier than expected. Basically, this happens even before the pharynx has time to open 8 cm. The reason for this is the high position of the fetal head, which makes it difficult for it to cling closely to the entrance to the small pelvis and begin to move forward. In this case, divisions amniotic fluid to the rear and front (as is normal) does not occur. This condition is dangerous, first of all, because in the absence of water, the umbilical cord loop or one of the child’s upper or lower limbs may fall out. At the same time, the opening of the uterus slows down, as a result, the first stage of labor takes longer, and the woman in labor loses a lot of strength that she might need in the future. If the duration of the water-free period exceeds 12 hours, there is a high probability of developing intrauterine infection, dangerous for mother and baby. Surgical delivery is prescribed immediately if the umbilical cord or any part of the child’s body prolapses;

anomaly labor activity. Prolonged labor is fraught with a decrease in the frequency and strength of contractions. At the same time, the child begins to suffer because he begins to experience intrauterine oxygen starvation. Because of this, the fetal heart rate first increases and then slows down. This is also a prerequisite for operative delivery;
risk of uterine rupture. During the pushing period of labor, a child with standard parameters is able to move forward due to the fact that the bones of his skull shift and the head takes on the optimal shape to overcome the plane of the small pelvis. A large baby usually has a head that is disproportionate to the mother’s pelvis. Because of this, excessive stretching of the lower uterine segment occurs, which can be complicated by uterine rupture;
the appearance of fistulas. Due to the long stay of the baby's head in one position in the pelvic plane, the cervix and vagina experience strong pressure. In addition to these organs, the bladder, urethra and rectum are also compressed. This leads to poor circulation in these areas, ischemia and death of soft tissue. After the birth of the baby, the affected areas are rejected by the body, after which the appearance of genitourinary and (or) rectovaginal pathological openings is noted;
rupture of the symphysis pubis. The large size of the fetal head can cause damage to the symphysis pubis in the form of ruptured ligaments and divergence of the pubic bones. Sometimes a woman in labor needs additional surgery after the baby is born;

shoulder dystocia in a child. When a large baby is born, problems often arise with removing the shoulders from the birth canal. This is mainly typical for children with signs of diabetic fetopathy, when the circumference of the shoulder girdle is much larger than the size of the head. Birth may cost the baby a fracture of the collarbone, humerus, or cervical spine;
cerebral hemorrhage in a child. When a large baby moves through the birth canal, his cranial bones are sharply displaced and compressed, which can cause hemorrhage in the brain or in the area under the periosteum.

Large fetus during pregnancy: how to give birth?

How will a big baby be born? naturally or with the help of a cesarean section - several factors will determine. Indications for planned surgical delivery are as follows:

Mother of a large child under 18 or over 30 years old.
The baby is in a position with his legs or buttocks down.
Post-term pregnancy.
Narrow pelvis of a woman in labor.
A large baby and abnormal structure or diseases of the uterus (for example, the presence of fibroids).
The expectant mother has contraindications to the period of pushing (heart disease, severe myopia).
The child has a large build and his mother has previously had obstetric complications (repeated cases of miscarriage, the birth of a stillborn baby, the use of assisted reproductive medicine methods for conception).

An emergency caesarean section can occur due to any delay during childbirth (for example, lack of full-fledged contractions, risk of uterine rupture, incorrect position of the head).

When doctors prepare for spontaneous childbirth in a woman, they must take into account:

the need for early diagnosis of a narrow pelvis in a woman in labor;
the need to monitor the birth process, contractions and the baby’s well-being;
the need to draw up a chart based on the duration of delivery, the dynamics of dilation, and the strength of contractions;
the need for analgesia and injection of antispasmodic drugs during childbirth;
the need to administer drugs with a reducing effect during the pushing period to prevent weak pushing;
the need for strict monitoring of the mother's condition in the first few hours after the birth of the baby, when there is a high risk of severe bleeding.

Children born rich are considered to be at high risk for the development of various diseases and mortality in the first month of life outside the womb, injury during birth (for example, a broken collarbone), suffocation, and the development of central nervous system pathologies.

Large fetus during pregnancy: important facts

All expectant mothers pregnant with a large fetus are advised to undergo hospitalization at 38–39 weeks. This is necessary for a complete examination of the pregnant woman, based on the results of which a labor management plan will be drawn up. If there is evidence, the medical commission will discuss the issue of planned caesarean section and preparation for surgery.
During the first pregnancy, birth in young women usually occurs naturally, even if the baby is diagnosed with heavy weight. Almost always in such cases, pregnancy proceeds without complications, and delivery ends successfully.
It is possible to prevent the development of a baby with a large weight with the help of a balanced and rational diet, the main program for which must be drawn up already in the first days of pregnancy. The expectant mother needs to calculate for herself the optimal ratio of proteins, fats and carbohydrates. You can’t eat for two, get carried away with unhealthy foods such as fried and fatty foods, sweets and baked goods. Instead, a pregnant woman should pay close attention to lean proteins, vegetables, unsweetened fruits and whole grains. As the due date approaches, the percentage of carbohydrates in the diet should gradually decrease.
If the attending physician does not object, it would not hurt the expectant mother to master a special set of gymnastic exercises for pregnant women, as well as move more (for example, go to the pool or fitness classes).

Having studied the reasons for the development of a large fetus during pregnancy and the consequences of this state of affairs for mother and child, let us summarize: despite the likelihood of many complications during pregnancy with a large fetus and childbirth, the vast majority of women safely give birth to absolutely healthy children. The key to success is self-confidence and complete trust in gynecologists and obstetricians.

The need for a cesarean section during pregnancy with a large fetus. Video

It's hard not to smile at a chubby baby: plump children always evoke genuine affection. Compared to a thin child, this one looks strong and healthy. People even often say that a chubby little one is sweet, tasty or appetizing. But these same people only rarely think about the fact that in fact this is not always good. Excess weight is dangerous even at this age, but problems begin in the womb...

The birth of a child with a large weight among ordinary people is mistakenly considered a sign of well-being. Meanwhile, a large fetus is associated with great risks, including for the mother.

However, you shouldn't think that this is a problem in any way. A large fetus during pregnancy is simply a risk factor. That is why you should learn more about this in order to prevent these same risks as much as possible.

How long is a large fetus during pregnancy?

For many years, in obstetrics, it was customary to consider a large newborn weighing more than 3600. However, today this figure has been revised.

IN Lately There has been a tendency towards an increase in the body weight of newborns. A child's weight at birth up to 4 kg is already considered normal. If it exceeds 4 kg, then they speak of a large baby, more than 5 kg - of a very large, “giant” one. Every year, the number of births of large children (which is called macrosomia in obstetrics) increases, as does the weight of newborns. However, in each individual case, a fruit with unequal weight will be considered large. So, if a woman has anatomically narrow pelvis or the fetus is positioned with the buttocks down, then in this case a fetus that has reached a mass of only 3.5 kg will be considered large.

In addition, when determining whether a fruit is large or not, it is also necessary to take into account its height, because tall children are always heavier than short ones.

In general, a large fetus (or macrosomia) is a baby whose birth may be difficult due to its size and weight.

How large the fetus is can really be judged by the midwife or neonatologist delivering the baby during the first examination of the baby. But preliminary forecasts are made long before the birth - without fail.

How to identify a large fetus during pregnancy

During a pregnant woman’s visit to the gynecologist, various measurements and studies are performed each time. Among other things, the doctor tries to make a preliminary assessment of the weight of the developing fetus (at a later date) by measuring the width of the pelvis, standing height of the uterus, abdominal circumference, pregnant woman’s weight and other parameters.

Ultrasound can more accurately determine the weight and height of the fetus during pregnancy, but even in this case, these parameters may differ from real ones by 10-15%.

Firstly, this gives the right to indirectly judge the well-being of the baby’s development. Secondly, in this way it is possible to promptly suspect the development of certain pathological conditions during pregnancy. Thirdly, the estimated weight with which the child will be born is very important in the sense that it largely allows us to predict the course of the birth process itself and the presence/absence of associated dangers.

If a woman regularly visits a gynecologist throughout her pregnancy and diligently undergoes all the examinations prescribed to her, then the likelihood of her developing a large fetus is determined very simply. It is almost impossible to suspect this on your own. Yes, many discomforts during pregnancy in the case of the development of a large baby appear more pronounced, but there may be completely different reasons for this, and there are many of them. And a large belly during pregnancy is not always evidence of the development of a large fetus. It is possible that a tiny baby lives in a big tummy.

The most reliable and accurate diagnosis of a large fetus during pregnancy is an ultrasound examination. And it is worth noting that such a diagnosis is very important, because sometimes based on this sign (the development of a large baby), one can suspect that a pregnant woman has serious diseases.

Large fetus during pregnancy: reasons

Most often, the baby gains excess weight in the womb along with his mother due to her diet. Excess weight gain is most promoted by the abuse of simple carbohydrates. The love for flour, confectionery products, and sweets results in extra grams and kilograms. But there are also other reasons for the formation of a large fetus during pregnancy:

Heredity. Of course, parents with large builds are likely to have rather large children. Even if you are slim and thin now, at birth things could have been different. Moreover, the size of a newborn’s head greatly depends on genetics: if the baby’s dad was also born big-headed, then the risks increase. Ask the grandmothers of the future baby, what weight they gave birth to. Most likely, history will repeat itself.
Number of births in the past. Practice shows that each subsequent child of the same woman is born weighing more than the previous one. But, of course, a large fetus during the first pregnancy is also not uncommon.
Wrong lifestyle. A pregnant woman who moves little and eats a lot of fried, fatty, carbohydrate foods will certainly gain extra pounds. And along with it, the baby will get heavier.
Rh conflict during pregnancy. If an Rh-negative mother carries an Rh-positive child, then such a pregnancy is associated with many risks. Among other things, fluid retention in the tissues of the fetus, which affects its weight and size.
Metabolism disorders (hypothyroidism, diabetes mellitus during pregnancy). Due to impaired metabolism, a lot of glucose enters the fetal blood, which contributes to weight gain. Often, it is a large fetus during pregnancy that is the basis for checking the expectant mother for her blood sugar level, since even if there were no deviations in this indicator before, now it is possible to develop gestational diabetes.
Reception medicines. There is an as yet unconfirmed theory that long-term use of certain medications can lead to weight gain in the fetus. Among them, in frequency, are agents for improving uteroplacental blood flow (such as Actovegin).
Condition and location of the placenta. There is an opinion among obstetricians that a large thick placenta may be one of the reasons for the formation of a large fetus during pregnancy, because in this case the baby is fed quite intensively. The location of the placenta along the posterior wall of the uterus also contributes to a more active supply of nutrients to the fetus.
Post-term pregnancy. A real post-term pregnancy, which may carry certain risks and dangers, is said to occur if the pregnancy continues for more than 10-12 days after 40 weeks. In this case, the child gains a large body weight and also has other signs of postmaturity (dry wrinkled skin, lack of vernix lubrication on it, long hair and nails, hardening of the skull bones, fontanelles beginning to close).

Some doctors, and at the same time women themselves, believe that a large fetus during pregnancy and vitamins have a direct relationship. As if multivitamin complexes for pregnant women cause the unborn child to gain additional weight. But, firstly, this theory has not been scientifically proven and is based only on personal experience and observations of doctors; secondly, numerous reviews on the Internet indicate that very often, when taking vitamins throughout the entire period of gestation, babies are born not only with an average body weight, but often even with a weight below normal. So it is still impossible to say with confidence that vitamins for pregnant women form a large fetus.

So, if it turns out that the fetus is expected to be large, the doctor will first have to establish the cause. The further management of pregnancy and preparation for childbirth will largely depend on it.

What are the dangers of a large fetus during pregnancy?

It is not at all necessary that a large baby will be a problem during pregnancy or during childbirth. But such a danger exists, and the larger the fruit and the more serious the reason that led to it, the greater it is.

Large fetus: features of pregnancy

The larger the fetus, the more space it requires inside the womb, which means the more the internal organs are infringed and the more stress they experience. In this regard, frequent urination, constipation, heartburn, shortness of breath may occur more severely and frequently.

The heavier the fetus, the more pressure it puts on the vena cava, and the greater the load on the musculoskeletal system, especially on the legs. And therefore the pain in ribs, back and lower back, varicose veins, fainting while lying on your back are quite normal phenomena for such a pregnancy.

Of course, the risk of stretch marks during pregnancy with a large fetus also increases, as does the risk of increased uterine tone.

Large fetus: features of childbirth

There are also risks during childbirth. The head of a large fetus does not fit tightly to the bottom of the pelvis, and the waters may not be divided into anterior and posterior. This means that when they leave, they come out all at once, which is worse for the baby’s condition, and they can leave earlier than expected (and a long waterless period during childbirth is associated with certain risks). Along with the water, umbilical cord loops may fall out into the lumen of the cervix, becoming pinched, or fetal limbs - in this case, emergency delivery must be resorted to.

Labor during the birth of a large baby is often weakened and contractions are painful. Due to the discrepancy between the fetal head and the width of the mother's pelvis, a caesarean section may be necessary. If childbirth takes place naturally, it is often protracted; obstetricians have to dissect the perineal tissue or resort to emergency caesarean section. Even after the baby has a large head, it may be difficult to move the shoulder joints out. Increased risk hypoxia During childbirth and the child receiving birth injuries, in particular, intracranial hematomas are formed, and during particularly difficult childbirth, cerebral hemorrhages can occur.

Prolonged labor can lead to infection of the birth canal and uterus.

In rare cases, when a very large fetus is born, the uterus may even rupture. Damage to the pubic bone and hip joints, muscle paresis, and neuralgic pathologies occur. Subsequently, inflammation in the area of the genitourinary tract and rectum of the woman who gave birth to the hero is also possible.

Often, after the birth of a large baby, postpartum recovery takes longer, spotting after childbirth lasts longer, and uterine bleeding may occur.

A large newborn baby may require more attention and need special care. But with proper organization, such a baby very quickly adapts to new living conditions and in no way lags behind other babies.

If the fetus is large during pregnancy: what to do?

Based on the reasons leading to the development of a large fetus, it is possible to identify pregnant women who are at risk for this indicator. Such women should do everything possible from the first days to reduce possible risks to a minimum.

Large fetus during pregnancy: diet

The first thing to start with is to properly organize your nutrition. It certainly must be complete and balanced. But if you have a tendency to gain excess weight - both the woman and the unborn child - you will have to exclude fatty, fried, sweet, mealy dishes and foods from the diet. The emphasis should be on lean protein, vegetables, unsweetened fruits and whole grains. The carbohydrate content of the diet will need to be reduced in late pregnancy.

It is possible that, for medical reasons, your doctor will prescribe you a diet or recommend fasting days during pregnancy. But such events cannot be organized without medical advice. But it won’t be superfluous to limit the caloric content of your diet: don’t eat for two - this is a big mistake!

If there are no contraindications to this, be sure to move a lot and do gymnastics. It will even be useful to visit a swimming pool or fitness center for pregnant women.

But the most important thing is not to worry too much. Under scrutiny medical supervision, a woman carrying a large fetus has a very high chance of giving birth safely and with minimal risks.

Large fetus during pregnancy: how to give birth - caesarean section?

Quite a large percentage of pregnancies in which the fetus develops large end successfully by natural birth. They are carried out under medical supervision with monitoring of the fetal heartbeat. Immediately after birth, the baby must be examined by a neonatologist, and it is also necessary to conduct some research to exclude problems in the health of the newborn, in particular diabetes mellitus and hemolytic disease.

But it is possible that the woman will have to prepare for surgery. A large fetus is an indirect indication for cesarean section. Surgical birth cannot be avoided if, in combination with a large fetus, there are other indications for cesarean section:

narrow pelvis during pregnancy;
polyhydramnios;
late gestosis;
diabetes mellitus during pregnancy;
decreased blood sugar levels;
premature discharge of amniotic fluid;
umbilical cord entanglement;
post-term pregnancy;
weak labor activity.

An emergency caesarean section for a large fetus can be performed in case of weak labor, prolonged labor, a clinically narrow pelvis (which is detected already during childbirth) or if there is a risk of uterine rupture.

In general, there is no particular reason for concern. Trust your doctor - and everything will go as well as possible. Do not refuse hospitalization in the final stages if you are offered this. Delivering a large baby with preliminary preparation and prenatal care is much easier and, in principle, correct. Medical control will significantly reduce possible risks and prevent complications.

In the end, many women give birth to large babies not only on their own, but also without any difficulties or complications! After all, childbirth in each individual case takes place in its own way, with individual differences and characteristics.

Therefore, do not be afraid of anything - you can cope with everything. Good luck with your birth! Wait for your heroes with love and impatience!

Especially for -Larisa Nezabudkina

A large fetus is sometimes a contraindication for natural childbirth. In each individual case, doctors make a decision individually, based on a number of indicators.

Which fetus is considered large during pregnancy?

Doctors say a baby is large if its weight before birth ranges from 4 to 5 kg. Children weighing over 5 kg are considered gigantic. Weighty babies have a correspondingly larger body length and circumference size.

Why can the fetus be larger than the term?

The baby in the womb grows according to certain patterns. The placenta is largely responsible for its development. If its functions are disrupted, the growth of the fetus slows down or accelerates, for example, this often happens in women with diabetes.

Thus, the reasons for excessive growth and largeness of the fetus can be:

Poor diet and lack of physical activity. High calorie food in tandem with a decrease in physical labor is the first reason for the increase in child growth. It is necessary to reduce the consumption of foods containing a lot of simple carbohydrates (pasta, confectionery and bakery products), and spicy aromatic substances that stimulate the appetite. A woman's obesity also affects her baby;
Features of the placenta. If it is large in size and volume, then the child will be larger than usual;
Increased volume and intensity of circulating blood. As a result, more nutrients are supplied;
Second and subsequent pregnancies. The uterus has greater extensibility, the vessels in its wall are already quite developed, the abdominal press provides less resistance;
Long-term and uncontrolled use of substances that improve uteroplacental circulation;
Heredity;
Endocrine metabolic disorders (diabetes mellitus, obesity);
Post-maturity;
Menstrual irregularities, history of inflammatory diseases.

Large fetus: nuances and features of the course of labor

Often, labor begins at the appointed time, but if you are postterm, it will be late, and if you have diabetes, it may begin prematurely.

Let's look at possible complications (their frequency increases as the child's weight increases).

Untimely discharge of amniotic fluid. It can be premature (before the onset of labor) or early (before the opening of the cervix). Both cases are associated with the lack of differentiation of the waters into posterior and anterior, high position of the head, features of the amniotic sac and polyhydramnios. The outflow may be accompanied by prolapse of the umbilical cord loop, which poses a threat to the baby’s life.

Abnormalities of labor (discoordination, weakness). Contractions are painful, irregular and of varying duration, or weak and infrequent, which causes a delay in the dilatation of the cervix. Weak labor forces are caused by overstretching of the uterus, a large placenta and the need to make significant efforts to move a large baby through the birth canal.

Hypoxia (lack of oxygen) can occur due to a long delay in childbirth, a woman’s fatigue, or infection due to an anhydrous interval.

Large fetus and clinically narrow pelvis. A complication occurs when the size of the baby’s head and the mother’s pelvis do not match (even if the latter is of normal size). In this case, in the absence of disturbances and good labor activity, childbirth occurs naturally.

Shoulder dystocia with a narrow pelvis. The head gradually moves forward, expanding the birth canal, but the shoulders may get stuck. The obstetrician must perform a series of techniques to free the shoulder girdle. Very often, such actions can lead to a broken collarbone, shoulder, or neck injury. Dystocia is often observed in large babies whose mothers suffer from diabetes.

An increase in the number of surgical interventions due to frequent complications during childbirth. Much more often they resort to a cesarean section with a narrow pelvis, weak contractions and efforts that cannot be corrected. Cesarean section is routinely used for breech presentation of a large fetus, a scar on the uterus, an older woman carrying her first child to term, the presence of diseases, complications during previous pregnancies and childbirth.

Amniotomy (artificial opening of the amniotic sac) and induction of labor detail. Basically, stimulation is planned from 38 weeks, when pregnancy is combined with extragenital pathology, and in case of post-term pregnancy.

What is the risk of complications?

Often during natural childbirth, the contractility of the uterus is disrupted, which is why bleeding occurs. Accordingly, the number of manual examinations of its cavity increases. During the examination, the unseparated parts of the placenta are removed and a massage is performed to promote muscle contraction and stop bleeding.

Dissections are widely used, since the risk of rupture of the vagina and perineum is high.

In women who give birth to heavy children, the involution of the uterus often slows down (reverse development), anemia occurs (hemoglobin levels decrease), and hypogalactia (insufficient milk). In those suffering from obesity: blood clots form (mainly in the legs), purulent-septic lesions are noted, endometritis (inflammation of the uterine mucosa), symphysitis, and mastitis occur.

Why should heavy children be supervised?

As for babies, they most often suffer from hypoxia and are born in a state of asphyxia. Also, in newborns, the adaptation period is longer than in children with normal body weight.

Often newborns have neurological disorders (tremor, anxiety). Such phenomena are provoked by a violation of cerebral circulation. Sometimes quite severe birth injuries occur. However, they can also occur during pregnancy complications.

Large babies may suffer from purulent-septic complications (eg inflammation of the umbilical wound), which are caused by primary immunodeficiency (decreased levels of immunoglobulins).

After birth, heavy children are under the supervision of a neonatologist, and subsequently - a pediatrician. They need to visit an endocrinologist and neurologist more often than others, because they are predisposed to obesity, diabetes, abnormalities in their neuropsychic status, and allergic reactions.

What to do if you are diagnosed with a large fetus

When the doctor said that the baby will be large, you should not panic, this can only do harm. A heavy baby means more careful monitoring is required during pregnancy and childbirth. Once the diagnosis is made, the doctor will try to find out the cause.

If excessive growth is caused by any pathology, treatment with medications in a hospital may be necessary until the birth itself.

When the reasons lie in heredity or obesity, a diet is prescribed so that the food does not contribute to excess weight gain, but supplies the body with the necessary nutrients. It is recommended to carefully monitor your diet in the first trimester to prevent significant weight gain, as well as do special exercises for pregnant women.

The decision to give birth is made purely individually. It is worth discussing this issue with your doctor, taking into account the peculiarities of the course of pregnancy. Sometimes a wait-and-see approach is chosen, in other situations a caesarean section is immediately prescribed.

Indications for surgical intervention already during childbirth are size discrepancies (large head, narrow pelvis), observed for more than 4 hours. Even if a natural birth is prescribed, they may resort to surgical procedures, but only if the life of the child or mother is threatened.

In the vast majority of cases, the woman is hospitalized before giving birth to prepare her. The process itself is carried out under strict monitoring control of the condition of the fetus and the contractility of the uterus. Doctors carefully monitor the rate of dilation of the cervix, insertion of the head and its advancement.

If the child is larger than normal, then in addition to monitoring the woman in labor, vitamin-energy complexes, pain relief, antispasmodics, artificial stimulation of labor, and prevention of fetal hypoxia are widely used.

It is believed that the best option if complications develop during natural childbirth is a cesarean section.

To prevent bleeding, a woman may be given a drug that helps contract the uterus, or put on an IV after childbirth. Even if the process goes well, careful monitoring of both the mother and the newborn is necessary.

Doctors recognize a large fetus before birth based on the ultrasound findings. The baby's weight increases most in the last 2 months of pregnancy. During this period, the main dimensions of a large fetus begin to exceed the norms corresponding to the gestational age. With a full-term fetus at 40 weeks, the main dimensions should not be greater than the following indicators: fronto-parietal skull size (FCR) - 120 mm, biparietal skull size (BSR) - 93.9 mm, hip length (HF) - 75.8 mm, the average diameter of the abdomen (AD) is 108.2 mm, the average diameter of the chest (SDCH) is 99.9 mm. If the fetus exceeds the specified sizes, you should expect the birth of a large baby.

You can assume that the baby will be large based on the size of the abdomen (its circumference and the height of the uterine fundus). However, in this case there is a risk of confusing a large fetus and polyhydramnios. With polyhydramnios, the size of the fetus may correspond to the gestational age or be smaller, but the abdomen may greatly increase in volume.

Causes of a large fetus

The baby's intrauterine development is genetically predetermined, but it is directly influenced by the state of the mother's body, the nutritional habits and lifestyle of the pregnant woman. The reasons for the development of a large fetus include errors in nutrition: excessive consumption of easily digestible carbohydrates, high-calorie foods in combination with low physical activity and low activity.

A large child may be born to parents who are obese. This disease is a consequence of a lipid metabolism disorder; it leads to an increase in the level of fatty acids in a woman’s blood, which penetrate into the fetus and significantly accelerate growth rates. Obesity of the father of the unborn child is considered a risk factor for the birth of a large fetus. Heredity influences the size of the fetus: physically developed, tall parents often give birth to large children.

The structural features of the placenta also influence: if its thickness and area increase, the intensity of blood circulation increases, the fetus receives more nutrients and stimulating hormones. The likelihood of giving birth to a large child increases with 2-3 pregnancies, since the vascular network of the uterus is better developed, creating good conditions for fetal development.

The fetus is larger if a woman suffers from diabetes. With this disease, the level of glucose in the blood is significantly elevated. It can easily penetrate to the fetus, resulting in disproportionate growth of the child and subcutaneous fat being deposited.