International Journal of Health and Pharmaceutical Fetal Macrosomia with Suboptimal Antenatal Care: A Case Report Alfun Dhiya An1,4*.
Indrahany Alwiandono1.
Asri Nur Maulidya2.
Restu Maharany Arumningtyas3 Department of Obstetrics and Gynaecology.
University Islam Indonesia Hospital.
Indonesia Faculty of Midwifery.
Institute of Health Science Rajawali.
Bandung.
Indonesia Department of Paediatrics.
University Islam Indonesia Hospital.
Indonesia Department of Obstetrics and Gynaecology.
Faculty of Medicine and Health Science.
Universitas Muhammadiyah Yogyakarta.
Indonesia *Correspondence author:
Email: alfundhiyaan@fkik.
Abstract.
Background: Fetal macrosomia is associated with increased maternal and neonatal Early detection relies on adequate Antenatal Care (ANC), including appropriate metabolic screening and serial fetal growth assessment.
Suboptimal ANC may delay the recognition of maternal risk factors and fetal overgrowth, particularly in high-risk Case presentation: We reported a case of a 46-year-old Indonesian multiparous woman with obesity who was referred from the Community Health Centre (CHC) to a secondary hospital due to post-term pregnancy, suspected fetal macrosomia, and advanced maternal age.
Despite multiple ANC visits, random blood glucose testing was not documented during Integrated Antenatal Care at the CHC, the primary healthcare Progressive excessive maternal weight gain and marked increases in fundal height were observed during the second and third trimesters without further metabolic evaluation.
An elective caesarean section was performed at 40 4 weeks of gestation, delivering a male neonate weighing 5,295 g.
Post-operative evaluation revealed maternal prediabetic status, while the neonate required monitoring due to macrosomia but remained clinically stable.
Conclusion: This case highlights the consequences of suboptimal antenatal screening and surveillance in high-risk pregnancies.
Failure to perform a timely metabolic assessment and respond to clinical indicators of excessive fetal growth may contribute to the delayed diagnosis of fetal macrosomia.
Strengthening the quality and completeness of integrated antenatal care, particularly at the primary healthcare level, is essential to improve early detection and prevent adverse maternal dan neonatal outcomes.
Keyword: Fetal macrosomia.
adequate Antenatal Care and A Case Report.
INTRODUCTION
Fetal macrosomia refers to excessive fetal growth and is commonly defined using an absolute birth weight rather than gestational age.
It is distinct from large for gestational age (LGA), which describes a birth weight above the 90th percentile for gestational age.
Although no universally accepted definition exists, birth weight thresholds of 4,000 g and 4,500 g are frequently used, with the risk of adverse maternal and neonatal outcomes increasing as fetal weight rises .
Macrosomia is associated with complication with complications such as labour dystocia, shoulder dystocia, birth trauma, and increased caesarean delivery rates.
However, current evidence indicates that suspected fetal macrosomia alone is not an indication for induction of labour, and delivery planning should involve individualised counselling based on estimated fetal weight, maternal risk factors, and clinical context .
This case highlights the challenges of detecting fetal macrosomia in the setting of suboptimal antenatal screening and multiple maternal risk factors, underscoring the importance of comprehensive antenatal care in preventing delayed diagnosis and adverse outcomes.
Case Report A 46-year-old Indonesian G3P2A0 woman was referred from the Community Health Centre (CHC) in Bantul.
Special Region of Yogyakarta, on January 5th, 2026, to the Universitas Islam Indonesia (UII) hospital.
The patient presented to UII Hospital on January 14, 2026, at 40 6 weeks of gestational age.
The CHC referred the patient due to a term pregnancy without spontaneous onset of labour, suspected fetal macrosomia, and advanced maternal age.
https://ijhp.
International Journal of Health and Pharmaceutical On arrival at UII hospital, the mother's body weight was 107.
3 kg, and her body height was 157 cm.
Blood pressure was normal at 116/81 mmHg, heart rate 85 beats per minute, and respiratory rate 20 beats per minute.
The ultrasound examination showed the fetal in an oblique position, with a normal heart rate and adequate amniotic fluid.
it estimated the fetal weight at 4,950 grams, and the fetalAos head had not entered the upper pelvic inlet.
The laboratory investigation results are shown in Table 1.
The working diagnosis was G3P1A0 post-term pregnancy, advanced age, obesity grade 3, and macrosomia.
Table 1.
Laboratory Examination Results No.
Examination PTT
PTT
PTT Control
APTT
APTT
APTT Control
Routine Blood
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
PLT
LYM%
MXD#
NEUT#
LYM#
MXD#
NEUT#
RDW-SD
RDW-CV
PDW
MPV
P-LCR
PCT
Random Blood Sugar (POCT) Laboratory Result Unit Seconds Seconds Seconds Seconds Thousands/mm3 Millions/uL gr/dL g/dL Thousands/mm3 10^3 / uL 10^3 / uL 10^3 / uL mg/dL An elective caesarean section was performed at 40 6 weeks of gestation.
A male neonate was delivered weighing 5,295 grams, with a length of 53 cm, and a head circumference of 38 cm.
The APGAR scores were 7 at 1 min and 9 at 5 min.
On admission to the neonatal unit for monitoring, the neonate was in good general condition, with adequate muscle tone and a strong cry.
Vital signs were stable: heart rate 130 beats per minute, respiratory rate 46 breaths per minute, body temperature 8 AC, and oxygen saturation 97% on room air.
Prophylactic intramuscular vitamin K .
was administered, along with ophthalmic prophylaxis, hepatitis B vaccination, and screening for congenital hypothyroidism and critical congenital heart disease.
Random blood glucose measurement was performed, with a result of 93 g/dL.
Further obstetric history revealed that this was the patientAos third pregnancy.
Her first child was delivered spontaneously by a midwife at a primary healthcare facility, with a birth weight of 3,200 grams.
The second child was delivered spontaneously by an obstetrician at a private hospital, with a birth weight of 3,800 grams.
During the current pregnancy, the mother had 9 ANC visits, but only 6 of those visits had their results well-documented.
Her first antenatal care (ANC) contact was on August 5th, 2025, at 18 weeks of gestation, conducted by the obstetrician at a private hospital.
The motherAos body weight was 70 kg at first contact and had normal blood pressure at 112/71 mmHg.
The second ANC contact was https://ijhp.
International Journal of Health and Pharmaceutical on August 8th, 2025, at an Independent Midwifery Practice.
Her second contact was at 18 weeks of gestation, with a body weight of 80 kg, maternal mid-upper arm circumference (MUAC) was 32.
5 cm, blood pressure of 103/72, a fundal height of 14 cm, and a fetal heart rate of 143 bpm.
The Independent Midwifery Practice referred the patient to CHC for integrated ANC.
Integrated ANC was conducted on August 9th, 2025, in CHC by a general practitioner, a dentist, midwives, and a psychologist.
Medical history on the current pregnancy showed that the mother had no previous illnesses, including hypertension, cardiovascular diseases, thyroid disease, or any allergy, autoimmune disease, diabetes, asthma, tuberculosis, hepatitis B virus, mental health issues, or sexually transmitted diseases.
The family medical history checklist and pre-pregnancy body mass index evaluation were not recorded in the pregnancy assessment form.
The mother did not use any contraceptive method before the current pregnancy.
General physical examination by the physician revealed no abnormalities in the conjunctiva, sclera, skin, neck, oral cavity, thorax, abdomen, and extremities.
Unfortunately, blood pressure examination results and weight measurements were not well documented in the maternal health book during integrated ANC.
Laboratory investigations revealed a haemoglobin level of 11.
7 g/dL, blood type B.
Rh-positive, and non-reactive results for HIV, syphilis, and hepatitis B.
No documentation of random blood glucose testing was found, although this test is routinely included in the basic laboratory screening at CHC.
The integrated antenatal care assessment concluded a diagnosis of G3P2A0 at 18 weeks of gestation, categorised as a high risk due to advanced maternal age, with a recommendation for continued ANC at the primary healthcare facility with intensive observation.
On September 18th, 2025, at 22 weeks of gestation, during the fourth ANC contact at the Independent Midwifery Practice, the motherAos body weight increased by 6 kg in 1 month, with blood pressure at 102/80 mmHg.
Fundal height became 28 cm, and fetal heart rate was normal at 145 bpm.
On November 26th, 2025, at 33 weeks of gestation, the mother had ANC in CHC.
Physical examination revealed a body weight of 97 kg, normal blood pressure of 107/72 mmHg, fundal height of 38 cm, and a fetal heart rate of 132 bpm.
On January 5th, 2026, at 40 weeks of gestation, the mother had another ANC visit at the same CHC, with a physical examination revealing a body weight of 100,5 kg, normal blood pressure of 124/77 mmHg, fundal height of 46 cm, and a fetal heart rate of 147 bpm.
After receiving antenatal care in CHC, the mother was referred to UII hospital to get further treatment by the obstetrician due to a term pregnancy without spontaneous onset of labour, suspected fetal macrosomia, and advanced maternal age.
In the UII hospital, the obstetrician recommends an elective caesarean section.
II.
DISCUSSION