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 (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.