A 34-year-old woman in her first pregnancy

A case in point

A 34-year-old woman in her first
pregnancy was referredat 34 weeks because her uterus seemed large for dates.Her mother was a diabetic but she was not tested for glucose intolerance until 30 weeks, at which time she had a 1-hour glucose screen of 160mg%. A full glucose tolerance test was positive, and her fasting sugar was105 mg%. She was put on a standard diabetic diet, but she missed her next appointment.Her fundal height was 38 cm when she showed up for her next visit at 36 weeks. The bio- metry was as follows: the BPD and HC were appropriate for 36 weeks,the AC at 38 weeks, and the long bones were compatible with 35 weeks. The EFW was 3700 g, well above the90th percentile. The largest vertical pocket was 8cm. Although no anomalies were noted, the interventricular septum measured 6.7
cm.We chalked up the macrosomia, body-to-head disproportion, thick septum (and even ample cheeks) to her glucose intolerance, which existed from early on. At 38 weeks, she went into labor. On admission theEFW was 3900 g, the (AAD)-BPD was 3.0 cm, andcheek-to-cheek diameter was 8.7 cm. She made sluggish progress in the active stage of labor, and we sectioned her rather than tempt fate later.The baby weighed 4400 g, had some transient tachypnea, and some brief hypoglycemia in the nursery.

Comment
The last EFW was off by 500 g, which is not atypical in macrosomia. The body-to-head disproportion in a fetus,seemingly weighing 3900 g, was not enough to
push toward a cesarian section on
admission, but this was certainly concerning enough to interdict an instrument delivery had she progressed to full dilatation.