Macrosomia

　　15. Fetal weight exceeding or reaching 4000g at birth is called a macrosomic fetus. In recent years, there has been a gradual increase in macrosomia due to excessive nutrition. The incidence in China is about 7%. The rate of cesarean section and mortality in macrosomic fetuses is significantly higher than that in normal fetuses. When the force of labor, the birth canal, and the fetal position are all normal, delivery difficulties often occur due to the large size of the fetus, leading to relative cephalopelvic disproportion.

　　14. 1. The incidence of macrosomia in pregnant women with diabetes is 26%, while the incidence in pregnant women without diabetes is only 5% to 8%.

　　13. 2. Nutrition and maternal weight Maternal obesity significantly increases the risk of gestational diabetes, macrosomia, and shoulder dystocia compared to those with lower weight.

　　12. 3. Genetic factors The occurrence of macrosomia is closely related to genetics. Parents with tall stature have a higher incidence of macrosomia in their children, and the incidence of macrosomia varies among different ethnic groups and races.

　　11. 4. Environmental factors Due to the low oxygen partial pressure in the air in high-altitude areas, the incidence of macrosomia is lower than that in plain areas.

　　10. 5. Number of deliveries Macrosomia is more common in multiparas.

　　9. 6. Prolonged pregnancy The incidence of macrosomia in prolonged pregnancy is 3 to 7 times higher than that in full-term pregnancy.

　　Impact on the child with a macrosomic fetus:

　　5. Leading to an extended delivery process: For women with normal height, pelvic shape, and size, delivery can be uneventful as long as the fetal position is normal when delivering a fetus weighing 3500 grams. However, if the fetus weighs more than 4000 grams, delivery becomes more difficult because the fetus's head and body are too large, making it difficult to enter the birth canal, resulting in an extended delivery process and eventually requiring the use of forceps or vacuum extraction to assist delivery.

　　4. Shoulder dystocia: In some cases, although the fetal head is delivered, the shoulders are stuck, and special obstetric methods must be used to deliver the fetus. This condition is medically known as 'shoulder dystocia'. This situation is rare in neonates weighing 3500 grams, but the probability of this condition increases significantly when the weight reaches 4000 grams. If the fetus weighs 4500 grams or even 5000 grams, the problem becomes even more serious, and the delivery process can be prolonged or even impossible, making it difficult to handle.

　　3. Neurological paralysis: The most terrifying is the occurrence of neonatal brachial plexus neuropathy during the delivery process. Severe shoulder plexus neuropathy can lead to lifelong disability, and the worst-case scenario is neonatal death.

　　Damage to the mother from a macrosomic fetus:

　　1. Causing birth canal laceration injury: Due to the large size of the fetus, delivery can be very difficult, leading to a prolonged labor, dystocia, and birth canal laceration injury. In severe cases, even uterine and bladder rupture can occur.

　　2. Postpartum hemorrhage: Due to the large size of the fetus, the uterus often does not contract well after the fetus is delivered, causing postpartum hemorrhage and even death.

　　Macrosomia not only poses certain risks to pregnant women but also manifests obvious symptoms in the infants, which can be harmful. The following are common clinical symptoms and treatment methods:

　　Newborn asphyxia: Macrosomia infants are prone to difficult labor and asphyxia.

　　Symptoms of the nervous system: Within one week after the macrosomia infant is born, varying degrees of nervous system symptoms may appear. During asphyxia, the blood oxygen concentration decreases, carbon dioxide accumulates, and leads to a decrease or cessation of cerebral blood flow, causing brain damage. This may include ischemic hypoxic encephalopathy, intracranial hemorrhage. The mild form is manifested by excitation symptoms, such as irritability, restlessness, prolonged eye opening, tremors, and increased muscle tone. The severe form is manifested by inhibition symptoms, such as drowsiness, coma, and decreased muscle tone, and seizures, apnea, and changes in pupils. Close observation and timely treatment of the infant's restlessness, crying, vomiting, bulging fontanelle, changes in consciousness, and increased muscle tone in the limbs, which are symptoms of intracranial hypertension, should be carried out in nursing care.

　　Brachial plexus injury and clavicle fracture: Both are caused by difficult labor due to mechanical factors. It is necessary to check the movement of the limbs carefully upon admission, diagnose and treat them early and correctly to prevent further injury. Clavicle fracture does not require special treatment, and it is better to minimize movement to reduce the risk of re-injury. The characteristics of brachial plexus injury are that the affected limb cannot move, the muscles are relaxed, the arm hangs down, and the sensation is dull.

　　Hypoglycemia: The offspring of diabetic mothers have high blood glucose and insulin levels before birth. After birth, due to the sudden interruption of glucose sources from the pregnant mother, while the insulin level in the blood is still high, it is easy to develop hypoglycemia and needs to be closely observed for clinical manifestations such as pale complexion, excessive sweating, cold limbs, and others.

　　Pulmonary hyaline membrane disease: Pulmonary hyaline membrane disease refers to the progressive respiratory distress that occurs within 6-12 hours after birth due to the lack of pulmonary surfactant. Due to the high blood glucose levels in diabetic pregnant women and their fetuses, the secretion of fetal insulin must increase at this time, converting glucose into glycogen. In this case, the fetus grows fat and large, but the lungs may not be fully developed, and insulin has an antagonistic effect on adrenal cortex hormones, affecting lung development.

　　Skin infection: Although macrosomia infants are heavier than other infants, their immune resistance is low, and due to the thick subcutaneous fat and excessive sweating, it is difficult to puncture. If improper treatment and care, it can lead to skin infection and the occurrence of sepsis.

　　Firstly, it is important to scientifically absorb nutrition during pregnancy: Medically, it is generally believed that the average birth weight of newborns being around 3000 grams is the most ideal number. The incidence of macrosomia can be reduced through human efforts. As early as the 1960s, the incidence of macrosomia in Japan reached 2%-3%, and by the end of the 1970s, it had risen to 4%. Due to the strengthened nutrition education during pregnancy, by the mid-1980s, the incidence of macrosomia decreased to 2% and has continued to the present. From the experience of Japan, the key lies in the change of concept, that is, during pregnancy, more is not always better in terms of eating and resting.

　　Second, strengthen prenatal nutrition education: The key to preventing the birth rate of macrosomia is to pay attention to the scientific intake of nutrition during pregnancy and adjust the rhythm of life. In major cities in China, prenatal health websites have been established universally, and many hospitals have special prenatal nutrition clinics to guide pregnant women on how to choose their daily diet reasonably. Therefore, it is best to go to the doctor regularly for nutritional guidance during pregnancy.

　　Third, persist in exercise during pregnancy: During pregnancy, pregnant women not only need to pay attention to reasonable community nutrition but also participate in appropriate exercise. For example, walking and doing prenatal health exercises can help burn excess calories, avoid overnutrition, and prevent macrosomia.

　　Finally, do a good job of diabetes screening during pregnancy: Gestational diabetes is one of the main causes of macrosomia, so it is very important to avoid giving birth to macrosomia by doing a good job of sugar screening during pregnancy. Every pregnant woman should do a sugar screen during pregnancy. Once gestational diabetes is found, follow the doctor's guidance, take in nutrition reasonably, avoid excessive fetal growth during pregnancy, and the risk of macrosomia.

　　B-ultrasound examination: measures the fetal biparietal diameter, abdominal circumference, femur length, etc., to predict fetal weight. When the fetal biparietal diameter is greater than 10 cm, and the abdominal circumference/femur length is greater than 1.385, 80% to 85% are considered macrosomia.

　　Pregnant women should pay attention to scientific diet from the beginning of pregnancy to prevent the occurrence of gestational diabetes. Adjusting the diet during pregnancy helps maintain the blood sugar level of pregnant women at a normal level, so that they do not feel hungry in daily life, and the nutritional supply can meet the needs of both the mother and the fetus.

　　1. Control the amount of food intake. In the middle and late stages of pregnancy, the appetite of pregnant women is better than in the early stage, and the amount of food intake will increase. It is very important to control the amount of food intake for pregnant women at this time. It mainly involves limiting the intake of staple foods such as rice, noodles, and potatoes, controlling the intake to about 5-6 catties per day. Do not eat foods high in sugar, as excessive intake of high-sugar foods can lead to high blood sugar, exacerbate the symptoms of diabetes, or lead to macrosomia.

　　2. Provide sufficient protein. The supply of protein during pregnancy cannot be too low, especially in the middle and late stages of pregnancy. Pregnant women should eat more soy products and coarse grains to increase the intake of plant protein. At this time, the development of the fetus and the brain mainly requires high-quality protein.

　　3. Provide an appropriate amount of fat. Due to dietary control, the supply of carbohydrate-rich foods for pregnant women decreases, so the intake of fat needs to be moderately increased to maintain daily energy supply. Eating some nuts can also help increase the fat intake.

　　4. Supplement vitamins and minerals. Eat more fresh vegetables to supplement vitamins, and eat some foods high in iron and calcium regularly, such as milk, fish, shrimp shell, and egg yolk to supplement minerals.

　　5. Eat less and more meals, and diversify food types. Pay attention to eating less and more meals during pregnancy, and eat foods rich in fiber, various vitamins, and trace elements. The variety of food should be diverse, mainly vegetables, soy products, lean meat, fish, eggs, and milk. After the second trimester, it is best to eat 5-6 meals a day, each meal should be 80% full.

　　6. Reasonable exercise. Many pregnant women become lazy due to pregnancy, which is actually extremely harmful to the development of the fetus. Pay attention to reasonable exercise during pregnancy, such as taking a half-hour walk every day, walking more after meals, converting excess sugar into energy and releasing it, so that it will not exist in the blood vessels, which is also a good way to prevent diabetes.

　　Pregnant women should increase the prevention and treatment of macrosomia during pregnancy and childbirth.

　　(1) If macrosomia is suspected during pregnancy, it is necessary to perform a glucose screening test in time to detect diabetes early and actively control blood sugar.

　　(2) For pregnant women with macrosomia, if the pelvis and fetal position are normal, they can try to give birth under strict observation. If the labor progress is not smooth, cesarean section should be performed.

　　(3) Macrosomia vaginal delivery should pay attention to shoulder dystocia. If shoulder dystocia occurs, the following measures should be taken for delivery: (1) Anterior shoulder delivery method: The midwife's hand is inserted into the vagina and placed behind the anterior shoulder of the fetus, during uterine contractions, push the anterior shoulder towards the oblique diameter of the pelvis to make it easier to enter the pelvis, then draw down the fetal head, and the assistant applies pressure on the symphysis pubis.

　　(2) Posterior shoulder delivery method: The midwife's hand is inserted into the vagina and placed behind the posterior shoulder of the fetus, and the fetal arm slides towards the fetal abdomen, while the fetal head is drawn down at the same time to assist in the delivery of the posterior shoulder.

　　For pregnant women with macrosomia, malpresentation, and gestational diabetes, cesarean section should be performed immediately.

　　Before vaginal delivery of a macrosomic baby, it is necessary to perform perineal episiotomy in time. After delivery, the soft birth canal should be carefully examined, and if there is any injury, it should be repaired. And pay attention to the prevention and treatment of postpartum hemorrhage.