a. Description.

An oversized baby is an infant that weighs more than 10 pounds (4500 grams).

The infant may be classified as large for gestational age (LGA). Most oversized babies are boys.

Usually, causes of oversized babies are maternal diabetes, postterm pregnancy, and inheritance from one or both parents who are large.

b. Complications.

(1) Shoulder dystocia. Wide shoulders of the fetus are likely to be a problem at the time of delivery. The fetus head may deliver, but the shoulders are too large for the pelvic inlet.

(2) Trauma to the birth canal may result during delivery due to the size of the infant. The trauma may be lacerations of the vagina or of the perineum.

(3) Trauma to the fetus as a result of pressure placed on it by the delivery process (especially the head and neck), may cause:

(a) Damage to the brachial plexus (nerve injury). This includes a network of lower cervical and upper dorsal spinal nerves, supply arm, forearm, and hand, may have flaccid arm, hand, forearm, and hand rotates inward. Damage to the brachial plexus may be referred to as Erb’s Palsy or Erb-Duchenne diseases. Damage is not usually permanent.

(b) Dislocation of the cervical vertebrae as a result of traction to get the infant out.

(c) Fracture of the clavicle. This is the most common problem and is done during delivery of the shoulders.

(d) Cerebral hemorrhage (intracranial). This is due to repeated pounding on the pelvis.

c. Medical Interventions for Delivery of the Oversized Infant.

(1) Assessment of feto-pelvic size to determine if vaginal delivery is possible.

(2) Monitor the patient’s progress closely.

(3) Perform cesarean section if the infant fails to descend.

(4) Fracture, intentionally, the humerus or clavicle to decrease the size of the fetus shoulder girdle and facilitate delivery. This is done if shoulder dystocia results during vaginal delivery. The mother may flex her thighs on her abdomen to enlarge her maternal pelvis inlet. Suprapubic pressure may be applied by someone to collapse the diameter of the shoulders.

d. Nursing Interventions.

(1) Monitor progress of the labor and the FHT’s closely for any signs of fetal distress.

(2) Keep the mother and father informed of the progress.

(3) Give emotional support to the parents.