The birth weight of the baby plays an important role. The adaptation of the baby after birth partially depends on it: for example, low-birth-weight children retain heat worse, but it is necessary.
During the first year of life, the weight with which the toddler was born will leave a serious imprint on the choice of feeding tactics, care, on the well-being and mood of the baby. It is good if the weight of the fetus is assessed as normal during pregnancy. But doctors often confront the expectant mother with a fact: a large fetus is expected, or, conversely, the child's weight does not "reach" the average norm. What are the features of such deviations during pregnancy and in childbirth, we will tell in this article.
Large fetus (macrosomia)
If the estimated weight of the baby is significantly higher than the norm, they speak of macrosomia - a large fetus. A large fetus at birth is considered a fetus weighing more than 4 kilograms. According to statistics, about 5-7% of newborns are born with such "heroes". The height of such children usually also exceeds the normative standard values. If the baby weighs 5 kilograms or more at birth, it is called a giant fetus.
Boys are more often born large, but this does not mean that the female fetus cannot show tendencies towards macrosomia. The size is usually diagnosed in the second trimester of pregnancy, more often - at the beginning of the third trimester, when the child begins to actively gain weight and "build up" subcutaneous fatty tissue.
Causes
Any baby is a child of his parents, and therefore the most common cause of fetal macrosomia is a genetic predisposition. If mom and dad are tall and large, or one of the parents has such a heroic build, then the chances that the fetus will be large are quite high.
Often, the fetus is considered normal during pregnancy, and macrosomia is determined only in the last weeks before childbirth. It is no secret that in the last months of pregnancy, the baby is actively gaining weight, so it can become large in case of a post-term pregnancy: after 42 weeks of pregnancy, up to 40% of children are born large.
Improper nutrition, in which a woman passes on, eats a lot of sweets, adds extra pounds to both her and her child. The fact is that the fetal pancreas is not able to produce as much insulin as it takes to break down the sugar obtained through the placenta with the mother's blood.
Also, children often become large if they are carried by women with diabetes mellitus diagnosed before pregnancy or gestational diabetes detected already during gestation.
Sometimes large parameters do not indicate fetal health at all. Excess of the estimated weight may be a consequence of intrauterine edema, which quite often affects children with a positive Rh factor, which are carried by Rh-negative women. The edematous form of hemolytic disease increases the weight of the fetus by 20-25%.
Certain pathologies of the placenta also contribute to fetal macrosomia. So, the large size of the "child's place" and the increase in its thickness lead to a more intensive exchange in the "fetus-placenta-mother" system, as a result of which the baby receives more nutrients, the products of its metabolism are excreted faster, which accelerates its growth and development. In addition to the nutritional function, the placenta is "engaged" in the production of hormones, and the larger placenta can produce them in greater quantities. This is also reflected in the growth rate of the baby.
Children who are second, third and fourth are almost always larger than their older siblings. Obstetricians believe that this is due to the stretching of the walls of the uterus: in a multiparous woman, the walls of the reproductive organ are more elastic, "stretched", so the fetus has more space for growth and development than it naturally cannot but use.
Obesity in the mother in 60% of cases leads to the birth of a large fetus, since metabolic processes are impaired not only in the woman, but also in the child she carries in the womb.
Drugs for improving uteroplacental blood flow ("Curantin", "Actovegin" and others) also contribute to an increase in fetal weight. Experienced obstetricians also note a connection with the age of a pregnant woman - most often children of expectant mothers who are not yet 20 years old, as well as women who are over 35 years old, are susceptible to macrosomia.
Bearing
A large belly is not at all a sign of the obligatory presence of a large fruit. Macrosomia is diagnosed not by the size of the abdomen, but by a set of signs, which include the height of the fundus of the uterus (exceeding by more than two weeks), ultrasound data, as well as data obtained by measuring the abdomen, taking into account the complexion of the expectant mother.
In the early stages, the size of the baby is not of great diagnostic value for determining macrosomia. The child begins to gain weight intensively in the womb after 20 weeks, respectively, diagnosis is possible only from the middle of the second trimester.
Pregnancy with a large baby can be a real challenge for a mother. A large fetus takes up a lot of space in the abdominal cavity, as a result, all the organs of a woman located in it are squeezed, they have to function to the limit in extremely cramped conditions. Therefore, constant severe heartburn, frequent urination are not excluded. If the baby tries to behave restlessly in the womb, actively moves, the baby's movements cause pain to the pregnant woman.
The load on a woman's legs during fetal macrosomia is higher, and therefore varicose veins and joint problems are not excluded. Stretching the skin on the abdomen almost always leads to the appearance of stretch marks.
During pregnancy, a large fetus is a risk factor for gestation. A red icon appears on the exchange card of the expectant mother, warning that the woman is at risk. She is recommended a diet with the exception of sweet and fast carbohydrates, as well as careful monitoring of the amount of fetal movements after 28 weeks and weekly recording of weight gain.
Vitamins for pregnant women and drugs to improve uterine blood flow are usually canceled so that the baby does not turn from large to giant.
Childbirth
How the labor will proceed depends on the size of the woman's pelvis, the estimated weight of the fetus, presentation and the mass of other obstetric factors. It is clear that with a narrow pelvis, naturally giving birth to a large child is quite problematic. But if the size of the pelvis is normal and corresponds to the size of the head according to the ultrasound data, if the fetus is in the correct cephalic presentation and there are no accompanying complications of pregnancy, the baby may well be born naturally.
Childbirth with a large fetus is often accompanied by an early outpouring of amniotic fluid. The big head of the baby cannot snuggle tightly to the outlet of the small pelvis and, as such, the separation of the volume of water into front and rear does not occur. If the outpouring is not just early, but also simultaneous, that is, there is a risk of the umbilical cord loop or the baby's limb falling out, this greatly complicates and delays the birth process. In such cases, with a long anhydrous period, a decision is made to perform an emergency caesarean section.
A large fetus that goes along the birth canal during childbirth creates risks of rupture of the uterus, vagina, cervix, and pubic symphysis injuries. The risks of birth trauma are also considered increased - due to the fact that the removal of the child's shoulders is difficult, there is a danger of a congenital traumatic fracture of the clavicle, injuries of the cervical spine.
In 80% of cases, doctors decide to conduct a planned cesarean section for women with large fetuses in order to reduce the possible risks that we have listed.
Hospitalization in a planned manner (for childbirth or cesarean section) with a large fetus should be carried out at 38 weeks of gestation, these are the recommendations of the Ministry of Health.
Small fruit
The fact that the fetus is small is said in cases where childbirth occurs on time and the weight of the child does not exceed 2.5 kilograms. Hypotrophy (decrease in body weight) is not always accompanied by a parallel decrease in the height of the child. Most often, a low weight is a sign of a fetus in the womb that is not well.
The prognosis for the course of pregnancy and childbirth depends on the cause of the low birth weight of the baby, if it can be determined.
Causes
First of all, it should be noted that the small size and small weight of the fetus, as in the case of large children, may well be due to genetic characteristics if the crumbs have thin and short mom and dad. Children from twins, triplets are also often small. Such reasons are considered physiologically and anatomically justified, doctors do not cause great concern.
In all other cases, diagnostics are carried out in order to establish the reasons why the baby does not gain weight in the womb. The most common diagnosis in this case is fetal growth retardation. Low weight can be a sign of chronic hypoxia caused by a wide variety of factors: insufficient nutrition, lack of vitamins and minerals in the required amount, pathologies of the placenta, umbilical cord, cord entanglement.
Any chronic diseases of the expectant mother, as well as acute infectious diseases suffered by her, contribute to a decrease in the weight of the fetus. Bad habits during gestation do not add health to either the mother or the child. Most often, low birth weight babies are born to women who smoke during pregnancy.
Children who have congenital malformations, as well as abnormalities in the genetic makeup (Down syndrome and other trisomies), are also characterized by low body weight. If screening tests, which are mandatory, have not shown high risks of having a “special” baby, other reasons why the baby is not gaining weight are considered.
Bearing
Methods for diagnosing fetal malnutrition - ultrasound, abdominal measurement (VSDM lags behind the standard values by about two weeks). But the reasons will help to understand the ultrasound with a Doppler and CTG. If the child has physiological thinness and diminutiveness, then the blood flow in the placental vessels will be within normal limits, and CTG will not reveal signs of a violation of the fetus.
Depending on what causes are identified and how great the lag in height and weight is, the woman will be prescribed treatment. It can be carried out at home or in a hospital - this question remains at the discretion of the treating doctor. The treatment regimen includes vitamins, vasodilating drugs ("Curantil", "Actovegin"). Ultrasound control is carried out regularly, which allows you to assess how much the baby has grown during the treatment.
A woman carrying a low-weight baby is recommended to eat abundant food, rich in proteins, slow carbohydrates, and vitamins. It is important to exclude the psychological factor: a woman should not be nervous, a child and she needs peace and comfort. Quite often, this cannot be achieved at home, and therefore doctors recommend hospitalization. Some pregnant women spend almost the entire pregnancy in a hospital, only sometimes returning home for a couple of weeks.
Birth
The mode of delivery and the timing of delivery are determined depending on the results achieved with the help of treatment. If the baby starts to gain weight, there is no need to rush to the hospital, you need to give the baby the opportunity to "catch up" with the norms and reach at least 2.5 kilograms. Therapy aimed at this will continue until the very birth. Low fetal weight is not a contraindication for natural childbirth.
If the child, despite all the efforts and efforts of the doctors, does not gain weight, the pregnancy is maintained until 36-37 weeks. At 36 weeks, a cesarean section can be performed for the fetus for health reasons.
When choosing a method of childbirth, the determining factor will not be the weight, but the condition of the child. A weak, low-birth-weight baby may not cope with the serious stress associated with the natural birth process. Doctors recommend a caesarean section to avoid losing your baby during childbirth.
If the baby, despite its small size, is quite active and presumably healthy, birth is allowed naturally. Do not think that giving birth to a small fetus is much easier than a baby of normal weight. A wide variety of factors can affect the birth process, and complications can also arise.
But there is no doubt that in the process of birth, a small baby does not create increased risks of rupture of the uterus and genital tract of the mother, and the risk of getting a birth injury to himself is also somewhat lower.
In this case, natural childbirth is tried to be carried out using spinal (epidural) anesthesia in order to achieve maximum relaxation and uniform disclosure of the cervix. The child is placed in a special heated bed, he is discharged home only after he reaches the weight of 2700 or 2800 grams.
Conclusions
Bearing and giving birth to both large and small babies has its own characteristics that a woman has to put up with. But in most cases, everything ends quite well - the birth of a normal child. During pregnancy, it is important to follow all the doctor's recommendations and in no case make diagnoses on your own - according to ultrasound tables or other data.
A large or small fetus can only be determined by a doctor, as well as the tactics of further management of the patient. Remember that a small belly is not a cause for concern, as it does not mean that the fetus is also small.
For information on what to expect with a large fruit, see the next video.
