From the Research
A cesarean section is typically recommended for a first-time pregnancy with a Large for Gestational Age (LGA) baby and Gestational Diabetes Mellitus (GDM) when the estimated fetal weight exceeds 4,500 grams or when there are additional complications present, such as poorly controlled diabetes, cephalopelvic disproportion, or signs of fetal distress. The decision to recommend a cesarean section over trial of labor depends on several specific factors, including the precise estimated fetal weight, the degree of maternal glucose control, presence of cephalopelvic disproportion (CPD), abnormal fetal position, maternal pelvic adequacy, and signs of fetal distress 1. Key considerations include:
- The severity of GDM and its management history, as poorly controlled diabetes increases the risk of macrosomia and associated complications
- Ultrasound measurements showing disproportionate growth, particularly of the fetal shoulders and abdomen relative to the head, which raise concerns about shoulder dystocia, a potentially dangerous complication during vaginal delivery
- Additional maternal factors such as advanced age, hypertensive disorders, or previous uterine surgery, which may further influence this decision
- The use of customized growth charts, which can help identify LGA infants at risk of complications, such as emergency caesarean section 2 The recommendation balances the risks of cesarean delivery against the potential complications of vaginal birth, including shoulder dystocia, birth trauma, and asphyxia, with the ultimate goal of ensuring the safest outcome for both mother and baby. According to the most recent study, customized growth charts can improve the detection of LGA infants at risk of complications, and women with an infant classified as AGA on population centiles but LGA when customised for height are at increased risk of intrapartum caesarean section 2.