Counselling a woman with suspected macrosomia — communication station

Communication station: tests the candidate on counselling a woman with suspected macrosomia — framing the EFW estimate honestly, explaining the shoulder dystocia risk and its weak prediction, presenting the induction evidence and the ACOG caesarean thresholds, and supporting an individualised decision. Includes assessor key, marking domains, and fail criteria.

Prompt

A 34-year-old G2P1 at 38 weeks gestation, no diabetes, attends the antenatal clinic after a growth scan showing an estimated fetal weight of 4250 g (over the 95th centile). Her first baby was 3.9 kg, vaginal birth, no complications. She has been told 'big baby, might need a caesarean' and is anxious. She asks you what her options are.

Station brief

Format. Communication station, approximately 12 minutes. You are the registrar in the antenatal clinic with a midwife. The assessor will play the woman; a second examiner observes the counselling and the decision-making. ^[1]

Candidate instruction. Counsel the woman on her growth scan result, the limitations of estimated fetal weight, the risks of macrosomia, the options for timing and mode of birth, and support her in an individualised decision. ^[1]^[5]

References6Show

[1]American College of Obstetricians (ACOG) Macrosomia: ACOG Practice Bulletin, Number 216 Obstet Gynecol, 2020.PMID 31856124
[2]Boulvain M, Senat MV, Perrotin F, Winer N, Beucher G, Subtil D, et al. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial Lancet, 2015.PMID 25863654
[3]Boulvain M, Thornton JG Induction of labour at or near term for suspected fetal macrosomia Cochrane Database Syst Rev, 2023.PMID 36884238
[4]Gardosi J, Ewington LJ, Booth K, Bick D, Bouliotis G, Butler E, et al. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial Lancet, 2025.PMID 40319899
[5]Moraitis AA, Shreeve N, Sovio U, Brocklehurst P, Heazell AEP, Thornton JG, Robson SC, Papageorghiou A, Smith GCS Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy PLoS Med, 2020.PMID 33048935
[6]Nesbitt TS, Gilbert WM, Herrchen B Shoulder dystocia and associated risk factors with macrosomic infants born in California Am J Obstet Gynecol, 1998.PMID 9731856

Counselling a woman with suspected macrosomia — communication station

Station brief

References6Show

[1]American College of Obstetricians (ACOG) Macrosomia: ACOG Practice Bulletin, Number 216 Obstet Gynecol, 2020.PMID 31856124
[2]Boulvain M, Senat MV, Perrotin F, Winer N, Beucher G, Subtil D, et al. Induction of labour versus expectant management for large-for-date fetuses: a randomised controlled trial Lancet, 2015.PMID 25863654
[3]Boulvain M, Thornton JG Induction of labour at or near term for suspected fetal macrosomia Cochrane Database Syst Rev, 2023.PMID 36884238
[4]Gardosi J, Ewington LJ, Booth K, Bick D, Bouliotis G, Butler E, et al. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial Lancet, 2025.PMID 40319899
[5]Moraitis AA, Shreeve N, Sovio U, Brocklehurst P, Heazell AEP, Thornton JG, Robson SC, Papageorghiou A, Smith GCS Universal third-trimester ultrasonic screening using fetal macrosomia in the prediction of adverse perinatal outcome: A systematic review and meta-analysis of diagnostic test accuracy PLoS Med, 2020.PMID 33048935
[6]Nesbitt TS, Gilbert WM, Herrchen B Shoulder dystocia and associated risk factors with macrosomic infants born in California Am J Obstet Gynecol, 1998.PMID 9731856