4.7 Abnormally large uterus

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 (macrosomia).

4.7.2 Management

– Verify the due date (date of last menstrual period).

– Perform ultrasound, if possible.

– Twin pregnancy (Chapter 6, Section 6.2), polyhydramnios (Section 4.8), molar pregnancy (Chapter 2, Section 2.3).

– Macrosomia:
Access to CEmoNC facilities need to be ensured due to the increased risk of foeto-pelvic disproportion and need for caesarean section. If referral of the patient during labour is likely to be difficult (distance, security), refer patient prior to onset of labour if feasible.
The risk of post-partum haemorrhage is increased: routinely insert an IV line.
Other risks associated with macrosomia include dynamic dystocia, prolonged labour, shoulder dystocia and perineal tear at delivery.