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Patient Information Service Women and children’s business unit Large for dates babies and polyhydramnios What does large for dates mean? From approximately 28 weeks of pregnancy your midwife will regularly measure the size of your tummy to monitor your baby’s growth. A tape measure is placed at the top of your uterus and measured to your pubic bone. This measurement is performed in centimetres. If the measurement is two centimetres greater than your dates the midwife will request a scan to check the growth of the baby and fluid around the baby. Scan findings The scan may confirm that baby’s estimated weight is above the 95th centile, however, it should also be acknowledged that ultrasound scans are only accurate to within ten per cent. However, the scan may show that your baby’s estimated weight is not above the 95th centile and the reason you were measured as large is that there is extra ‘water’ (liquor) around your baby. This is known as polyhydramnios and occurs in less than one per cent of pregnancies. 1 What tests will be offered if my baby is above 95th centile or I have polyhydramnios? Gestational diabetes could be the cause in either case. You will be offered either a Glucose Tolerance Test (GTT) or Home Blood Glucose Monitoring (HBGM) depending on how many weeks pregnant you are. If any result is suggestive of gestational diabetes we will offer a referral to the diabetic specialist midwife who will advise you on diet and blood sugar monitoring. A consultant appointment will also be arranged and plans for the remainder of your pregnancy and for delivery will be discussed with you. Above the 95th centile – will I be able to have a normal delivery? If your baby has been identified as large for dates you will be offered an appointment with a consultant obstetrician. The current recommendations are that elective caesarean section is only recommended if the baby’s weight is estimated to be above 5kg. Early induction of labour is also not advised solely for a large baby as this can increase your risk of needing a caesarean section and associated problems for you and your baby. 2 The main anticipated concern is that your baby’s shoulders may get stuck during delivery (after the head is born) and for this reason a hospital birth in the central delivery suite will be advised. Difficulty in delivering the shoulders is called ‘shoulder dystocia’. Midwives and obstetricians will be alert for any signs in order to anticipate difficulty with the shoulders. However this happens very rarely and there are specific manoeuvres to help release the shoulders. All midwives and obstetricians are trained to deal with shoulder dystocia. What does this mean for my baby? If there is difficulty in delivering the baby’s shoulders, the paediatrician (baby doctor) will be called to be present at the birth. Up to ten per cent of babies with a shoulder dystocia can experience nerve damage (brachial plexus injury) which may cause loss of movement to the baby’s arm. This is usually temporary but for a small number of babies this may be permanent. Other injuries can be sustained, such as fractures of the baby’s arm. These fractures tend to heal without problems. It is important to highlight that this can also happen at births not complicated by shoulder dystocia. Sadly, in very rare cases even when the best care is provided a baby can suffer brain damage if there is a delay in delivering the baby, and may even die. 3 Polyhydramnios – will I be able to have a normal delivery? Current recommendations do not support early induction of labour or elective caesarean section. If the polyhydramnios has been classified as moderate or severe we will recommend that you deliver on the central delivery suite, however if it is classified as mild and you are otherwise low risk, you may be able to deliver on the midwifery led birth unit after discussion with your midwife. If you have polyhydramnios you have an increased chance of your waters breaking early or going into labour early, both are due to the overstretching of your uterus. We advise you to call the hospital immediately if you think your waters have broken or labour has started because there is an increased risk of the umbilical cord slipping into the vagina if the baby’s head is not engaged and this may affect your baby’s health if delivery is not carried out immediately. Due to the overstretching of the uterus there is an increased risk of bleeding after the baby is born and you will be advised to have an actively-managed third stage of labour (delivery of the placenta) to reduce this risk. However if bleeding is excessive, a blood transfusion may be required. 4 Polyhydramnios – what will this mean for my baby? If gestational diabetes has been ruled out as a cause for polyhydramnios you may be offered screening for infection, and additional scans and monitoring may be requested depending on the level of fluid seen on scan. An individualised plan of care will be made with you. A paediatrician will check the baby soon after delivery and before baby has his/her first feed. This is to rule out a rare congenital problem where there is a blockage in the oesophagus (swallowing tube) which causes polyhydramnios if baby cannot swallow the amniotic fluid as would normally occur; hence the fluid builds up during pregnancy. The paediatrician will gently pass a tube down baby’s nose and into the stomach to ensure there is no blockage. Further reading Royal College of Obstetricians and Gynaecologists (RCOG) Shoulder Dystocia – Green-top Guideline No. 42 (2012) Royal College of Obstetricians and Gynaecologists (RCOG) Umbilical Cord Prolapse – Green-top guideline No. 50 (November 2014) 5 Patient Information Service If this leaflet does not answer all of your questions, or if you have any other concerns please contact the antenatal triage on: 01702 385301. www.southend.nhs.uk For a translated, large print or audio tape version of this document please contact: Patient Advice & Liaison Service (PALS) Southend University Hospital NHS Foundation Trust Prittlewell Chase Westcliff-on-Sea Essex, SS0 0RY Telephone: 01702 385333 Fax: 01702 508530 Email: [email protected] Written by PIPMS Reviewed by Andrea Harrington and Deborah Edwards June 2016 Leaflet due for revision June 2018 Form No. SOU1580 Version 3