A woman with diabetes has a fetus estimated above the 90th centile for weight. Which single intrapartum complication should be anticipated?

Answer: E. Shoulder dystocia

Macrosomia and shoulder dystocia

Maternal hyperglycaemia drives fetal hyperinsulinaemia and excess growth.

This case

• A fetus above the 90th centile (macrosomia) is at increased risk of shoulder dystocia during vaginal delivery (the shoulders impact after the head delivers).

Why it matters

• Shoulder dystocia is an obstetric emergency risking brachial plexus injury, fractures and hypoxia.
• Anticipation, senior help, and manoeuvres (for example McRoberts position, suprapubic pressure) are needed; macrosomia may influence the mode and timing of delivery.

Other macrosomia effects

• Operative delivery, birth trauma, neonatal hypoglycaemia.

So shoulder dystocia should be anticipated with macrosomia.