Monitoring pregnancy and labour

Scans are used in pregnancy to determine the growth and health of the foetus. Ultrasound measurements have been commonly used to detect fetal macrosomia, when a baby in the womb is significantly larger than average. It can be hard to accurately tell a baby’s weight from the size of a mother’s tummy during pregnancy.

Women carrying larger than average babies may be at more risk of complications during the delivery. Babies born weighing between 8lb 130z to 9lb 15oz or greater than 90 per cent for gestational age after correcting for sex and ethnicity, are more likely to suffer shoulder displacement during vaginal delivery. The mother is also more likely to suffer tearing of the birth canal. In some cases, women may choose to have a C-section with advice from their doctor or midwife.

However,  new advice from the Academy of Medical Royal Colleges suggests that ultrasounds are pointless unless a mother already had diabetes, which causes high blood sugar levels and is a leading cause of heavy birth-weight babies.

The reason for this is that ultrasounds are often inaccurate – up to 20 per cent out in some cases – and the best way to diagnose fetal macrosomia is after delivery.  These scans could therefore be seen as a waste of resources unless a mother has a recognised risk.

Dietary adjustments are the main treatment for suspected macrosomia.

The advice that electronic fetal monitoring during labour should only be reserved for women considered at risk because of their age or a preexisting medical condition, is more controversial, however.

In my opinion, a simple intervention like electronic fetal monitoring should not be reserved for the few who have obvious issues. What about the babies that have problems with the cord in utero which causes oxygen deprivation? This isn’t going to be something you can predict but a monitor can quickly show fetal distress in time for something to be done. I don’t think it is up to doctors to dictate whether this is provided or not. After all, they are not the ones taking home a baby with cerebral palsy, brain damage or no baby at all in the case of stillbirth.

The Royal College of Obstetricians and Gynaecologists has said that it is ‘in support’ of patients having fully informed and open conversations with their doctors about any treatment, procedure or test. They confirm what I feel – that this needs to be about patient choice with the facts laid out clearly.

‘Patients should feel comfortable to ask their doctor whether a treatment, procedure or test is necessary, what the possible risks and side effects are, whether there are simpler, safer options, and what will happen if they do nothing. These discussions should help allay any confusion and anxiety from the patient, and help both the patient and doctor agree to future steps.’

 

Mr Mike Bowen

Mr Mike Bowen is a consultant obstetrician and gynaecologist at Medical Legal Chambers UK.

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