Society for Maternal-Fetal Medicine

View all recommendations from this society

March 10, 2021

Don’t recommend delivery in a nondiabetic patient for suspected macrosomia before 39 0/7 weeks of gestation.

Recommendations regarding the optimal timing of delivery seek to balance maternal and perinatal risks. Delivery before 39 0/7 weeks of gestation without medical indication has been associated with increased adverse perinatal outcomes compared with those at or beyond 39 weeks of gestation. For suspected macrosomia, the accuracy of estimated fetal weight using sonographic and clinical estimates is inherently imprecise. In addition, the data comparing delivery to expectant management for suspected macrosomia are inconsistent with regard to reducing the risk of shoulder dystocia, especially when weighed against the harms of early delivery. Given the imprecision in fetal weight assessment, the increase in adverse perinatal outcomes, and the limited data demonstrating benefit, delivery before 39 weeks of gestation is not recommended for suspected macrosomia in nondiabetic patients.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

As a national medical specialty society, the Society for Maternal-Fetal Medicine relies on the input of any number of its committees in the development of various documents. In the case of the items included in this list, the Publications Committee reviewed the literature and evidence from SMFM’s published documents for possible topics. For SMFM’s first set of five recommendations a sub-group of the Committee initially developed a list of 10 items that the Committee then ranked for the top five with input and suggestions by the Society’s Executive Committee. For SMFM’s second set of recommendations, the sub-group of the Committee developed a list of 12 items that the Committee then ranked for the top five, again soliciting input and suggestions by the Society’s Executive Committee. For SMFM’s third set of five recommendations, the sub-group of the Publications Committee developed a list of 10 items that the Committee ranked for the top five, again soliciting input and suggestions by the Society’s Executive Committee. The final lists have been reviewed and approved by the Society’s Document Review Committee and Executive Committee.

SMFM’s disclosure and conflict of interest policy can be found at www.smfm.org

Sources

Parikh LI, Reddy UM, Männistö T, et al. Neonatal outcomes in early term birth. Am J Obstet Gynecol 2014; 211(3): 265.e1-265.e11.

American College of Obstetrics and Gynecology. Macrosomia: ACOG Practice Bulletin, Number 216. Obstet Gynecol 2020;135(1):e18-e35.