Information sharing and communication in management of large for gestational age babies in non‐diabetic mothers

Abstract

Key content There is no specific UK guideline on how to identify or manage large for gestational age (LGA) fetuses in non‐diabetic mothers. There is conflicting evidence with regard to the optimal mode and timing of delivery in such women and babies in order to minimise the possible risks. Pre‐delivery patient–clinician discussion on management and mode of delivery in LGA babies can be challenging due to the lack of conclusive evidence and guidance for both screening and interventions, but it is crucial in order to facilitate information sharing, counselling and collaborative decision making. Decision‐making tools could help to facilitate these discussions and ensure ‘material risks’ are discussed. Learning objectives To be aware of the limitations of available methods for screening for LGA fetuses, specifically symphyseal fundal height and ultrasound estimation of fetal weight. To understand the lack of robust evidence for obstetric interventions, which makes it difficult to convey clear information in a practical and useful way. To consider the use of decision‐making tools (such as BRAIN and iDECIDE), which can provide a framework for shared decision making, particularly when the evidence is limited or conflicting. These tools offer a structure which empowers patients to weigh up information as well as assist clinicians in determining what is considered ‘material risk’ when counselling in line with the Montgomery ruling. Ethical issues The Montgomery ruling advises that doctors must discuss any ‘material risks’ involved in a proposed treatment and offer other reasonable alternatives. Clinicians, therefore, have a duty to be transparent about the lack of strong evidence to recommend one mode of birth over another but at the same time acknowledge that individual preference and perceptions need to be explored to enable personalised decision making.