Macrosomia

• Definition: Birth weight greater than 4000 g or above the 90th percentile for gestational age



• Causes: Maternal diabetes or obesity, excessive weight gain during pregnancy, prolonged pregnancy (>40 weeks), male gender, genetic factors
• Signs and symptoms: Large size for gestational age (LGA), plump or full face, birth trauma (e.g., shoulder dystocia, brachial plexus injury), hypoxemia (low oxygen level in blood), hypoglycemia, hypocalcemia (low calcium level in blood), polycythemia (high red blood cell count), hyperbilirubinemia
• Assessment: Measure weight, length, head circumference; monitor vital signs and oxygen saturation; assess for signs of trauma or injury; perform heel stick blood glucose test using a glucometer; perform laboratory tests as ordered (e.g., blood gas analysis, calcium level, hematocrit); perform diagnostic tests as ordered (e.g., chest X-ray)
• Nursing interventions: Deliver the baby vaginally with assistance if needed (e.g., forceps, vacuum extraction) or by cesarean section if indicated; provide oxygen therapy if needed; maintain thermoregulation by keeping the baby warm and dry; feed the baby as soon as possible after birth; monitor blood glucose levels frequently until stable; administer IV dextrose solution if needed; monitor calcium levels and administer calcium gluconate if needed; monitor hematocrit levels and perform partial exchange transfusion if needed; monitor bilirubin levels and provide phototherapy if needed; educate parents on signs of hypoglycemia and how to feed the baby