Delivery complications Because of the infant's large size, vaginal delivery may be difficult and occasionally results in birth injury, particularly including Shoulder dystocia Fracture of the clavicle or limbs Perinatal asphyxia Other complications occur when weight is > 4000 g. There is a proportional increase in morbidity and mortality due to the following: Respiratory distress (and need for ventilatory assistance) Meconium aspiration Hypoglycemia Polycythemia Infants of diabetic mothers (IDMs) IDMs are at risk of Hypoglycemia Hypocalcemia and hypomagnesemia Polycythemia Hyperbilirubinemia Respiratory distress syndrome Certain congenital anomalies Hypoglycemia is very likely in the first few hours after delivery because of the state of hyperinsulinism and the sudden termination of maternal glucose when the umbilical cord is cut.