4.7 Abnormally large uterus

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    4.7.1 Diagnosis

    Fundal height greater than the presumed gestational age.

     

    The possible causes are:
    – Incorrect due date;
    – Multiple pregnancy, polyhydramnios, molar pregnancy;
    – A large-for-gestational-age foetus (foetal macrosomia).

    4.7.2 Management

    – Verify the due date (date of last menstrual period).
    – Perform ultrasound, if possible.
    Depending on the diagnosis: twin pregnancy (Chapter 6, Section 6.2), polyhydramnios (Section 4.8), molar pregnancy (Chapter 2, Section 2.3).
    – In the event of foetal macrosomia:
    There is an increased risk of foeto-pelvic disproportion. Anticipate the need for referral to a CEmONC facility during labour for caesarean section if necessary. If referral is difficult (distance, security, etc.), refer patient prior to onset of labour. 
    The risk of postpartum haemorrhage is increased: routinely insert an IV line.
    Other risks associated with foetal macrosomia include dynamic dystocia, prolonged labour, shoulder dystocia and perineal tear at delivery.