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Like adults, unborn babies come in all shapes and sizes. An adult’s shape and size can absolutely affect their overall health. In an unborn baby, being too big or too small can cause serious problems, potentially for the baby and the mother, in the periods before, during, and after birth.
“Fetal macrosomia” is when a baby weighs more than eight pounds, 13 ounces at birth or any time before birth. It also describes an unborn who is 90% or more of the average weight for a baby at the same gestational age.
Sometimes, a baby is just… large. But the doctor should closely monitor a baby’s fetal size, along with any conditions or complicating factors for the mother.
Is fetal macrosomia a result of medical malpractice?
This is a two-pronged question.
Is fetal macrosomia the result of medical malpractice? No. There’s nothing a doctor could do to causemacrosomia. The doctor also can’t prevent macrosomia. The baby will grow based on genetics and other factors.
The second question is whether the doctor diagnosed macrosomia and took measures to prevent resulting harm.
Medical malpractice is when a doctor or other medical professional fails to provide diagnostics or treatment according to the appropriate standard of care, and that failure results in injury or further illness.
Failure to diagnose an illness or condition—when monitoring or testing for that particular condition is standard—can be malpractice.
You can’t put an unborn baby on a scale and weigh them as you would any other person, but certain tests and measurements alert the doctor that the baby has macrosomia or is at risk.
If a doctor is aware that a baby has macrosomia, the doctor can (and should) take preventive measures to alleviate risks for both the baby and the mother. Failure to do so could be medical malpractice that leads to a birth injury.
Symptoms of macrosomia
There are two primary ways a doctor would diagnose macrosomia.
Distance from pregnant person’s uterus to the top of their pubic bone
The mother’s fundal height is measured each time she has a prenatal visit with her doctor. Beginning at about 20 weeks gestation, this is a predictor of fetal size. The doctor can estimate the baby’s size, growth rate and position using this measurement. In general, the height of the fundus should be equal to the number of weeks’ gestation. If it’s much larger, the doctor should take further steps to assess for macrosomia.
Excessive amniotic fluid
Amniotic fluid surrounds the baby in the womb. There is more amniotic fluid when the baby produces more urine; a larger baby produces more urine than an average-sized baby. Therefore, when there is more than the typical amount of amniotic fluid in the womb, it should signal the doctor that the baby could be larger than its expected size.
Causes of macrosomia
There are a few risk factors that would make it more likely for a baby to have macrosomia:
- Mother had diabetes prior to pregnancy
- Mother had macrosomia in earlier pregnancies
- Above average weight gain during pregnancy
- Male fetus
- Mother’s height and weight at birth
- Mother is younger than 17 years old
- Twins or more (multiparity)
- Mother’s pre-pregnancy weight
- Longer than 40 weeks’ gestation
Risks associated with macrosomia
Macrosomia, itself, is not a birth injury. The reason a doctor should properly diagnose macrosomia is that a vaginal delivery of a baby with macrosomia could cause a birth injury to the baby or the mother.
Macrosomia risks to the baby during birth and childhood
Your baby could experience:
- Low blood sugar at birth
- Childhood obesity
- Metabolic syndrome, including increased blood pressure, high blood sugar, excess body fat, and abnormal cholesterol
Macrosomia risks to the mother during labor and delivery
There are several complications a woman giving birth could experience if the baby has macrosomia:
- The baby could become “stuck” in the birth canal, known as shoulder dystocia, or experience other birth injuries.
- Genital tract lacerations, which are tears in vaginal tissues and the perineal mucles (between the vagina and the anus)
- Severe bleeding if the uterine muscles don’t contract correctly (uterine atony)
- Uterine rupture, when the uterus tears (usually because of a previous C-section or other surgery)
Treatment for macrosomia-related issues
A pregnant mother could reduce the risks of ongoing issues to a child born with macrosomia by monitoring weight during pregnancy and managing diabetes properly.
Injury to the mother could be prevented by having a C-section (Cesarean section) delivery rather than a vaginal delivery.
Macrosomia and medical malpractice
Your doctor can’t cause your baby to be too large. But standard prenatal care includes measuring fundal height and ultrasounds that determine the amount of amniotic fluid. Ultrasounds are also a way to measure the baby, and they can provide clues as to the baby’s size.
If your doctor does not perform routine testing, or if they perform the tests and misinterpret or ignore the results, it could be malpractice if there’s a negative outcome—like an injury to the mother or baby as a result of the missed information.
If you believe that your birth injury (or your baby’s) was the result of medical negligence, you should first seek a diagnosis from a separate doctor (one who is in a different medical practice or group). If the doctor thinks your medical concerns (or your baby’s) are the result of macrosomia that was undiagnosed by your obstetrician during pregnancy, you might be a victim of medical malpractice.
If you believe you can make a claim for medical malpractice, you should contact an attorney who specializes in birth injuries immediately for guidance on how to preserve your claim and your legal options.
See our guide Choosing a personal injury attorney.