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Reproduction Week 3 2018/19 > 7: Problems in pregnancy - large for dates > Flashcards

7: Problems in pregnancy - large for dates Flashcards

1
Q

What centiles are babies likely to be above/below if they are

a) large for dates
b) small for dates?

A

a) > 90th centile
b) < 10th centile

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2
Q

What is the definition of a large-for-dates baby?

A

Fundal height > 2cm greater than expected for gestational age

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3
Q

What is an innocent reason for a large-for-dates baby?

A

Mother has given the wrong dates

i.e can’t remember when her last pregnancy was, or has concealed it

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4
Q

Is macrosomia always caused by diabetes?

A

No, can occur on its own to produce a large-for-dates baby

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5
Q

What are three reasons for a large-for-dates pregnancy?

A

Multiple pregnancy

Foetal macrosomia

Gestational diabetes (causing macrosomia)

Polyhydramnios

Wrong dates given

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6
Q

How is foetal weight estimated?

A

Using ultrasound measurements - abdominal circumference and femur length

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7
Q

Macrosomia describes a foetus above which weight centile?

A

> 90th centile

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8
Q

What disease must you exclude in foetal macrosomia?

A

Maternal diabetes

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9
Q

What does dystocia mean?

A

Obstructed birth

e.g large-for-dates babies who can’t squeeze through the birth canal

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10
Q

What complication of pregnancy, causing brachial plexus injury or clavicle fracture, may occur in macrosomic babies?

A

Shoulder dystocia

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11
Q

What are the three options in managing foetal macrosomia?

A

Conservative - wait for due date and see what happens

Induction of labour

Caesarean section

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12
Q

What is polyhydramnios?

A

Excess amniotic fluid

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13
Q

How is excess amniotic fluid detected?

A

Abdominal examination - increased fundal height, increased liqour

Ultrasound measurements

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14
Q

What amniotic fluid index on ultrasound is diagnostic of polyhydramnios?

A

> 25cm

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15
Q

What is the depth of amniotic fluid diagnostic of polyhydramnios on ultrasound?

A

> 8cm

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16
Q

What is the

a) amniotic fluid index
b) pool depth

diagnostic of polyhydramnios?

A

a) API > 25cm

b) Deepest pool > 8cm

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17
Q

What endocrine disease can cause polyhydramnios?

A

Maternal diabetes

This seems like a safe answer for any problem in pregnancy tbh

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18
Q

Which type of pregnancy may cause polyhydramnios?

A

Multiple pregnancy

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19
Q

Polyhydramnios can cause __-__ labour.

A

pre-term labour

i.e premature birth

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20
Q

What is the main symptom of polyhydramnios?

A

Abdominal pain

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21
Q

What are the physical signs of polyhydramnios?

A

Tense, shiny abdomen

Inability to feel foetal parts

Excess liquor

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22
Q

What test should be done for all patients with suspected diabetes?

A

2 hour OGTT following overnight fast

This is the standard Ix in pregnant women with suspected gestational diabetes

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23
Q

If a patient with polyhydramnios hasn’t given birth by 40 weeks, how should it be managed?

A

Induction of labour

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24
Q

What is the definition of multiple pregnancy?

A

Presence of > 1 foetus in the womb

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25
Q

What infertility therapy increases a woman’s chances of multiple pregnancy?

A

Assisted conception therapy

26
Q

Why does ACT increase a woman’s chances of multiple pregnancy?

A

Multiple embryos/zygotes can be artificially to increase chances of success

But if > 1 of those are successful then multiple pregnancy occurs

27
Q

People from which part of the world are more likely to have multiple pregnancies?

A

Sub-Saharan Africa

28
Q

What is the cause of monozygotic twins?

A

Splitting of one fertilised egg

29
Q

What is the cause of dizygotic twins?

A

Two separate ova fertilised by two separate spermatozoa

30
Q

Apart from zygosity, what other factor are twins described in terms of?

A

Chorionicity

i.e if there are one or two placentas

31
Q

Dizygous twins always have ___ placenta(s) and ___ amniotic cavity / cavities.

A

dizygous twins –> two placentas, two amniotic cavities

i.e DCDA (dichorionic diamniotic)

32
Q

What four forms can monozygous twins develop in?

A

DCDA - two placentas, two amniotic cavities

MCDA - shared placenta, two amniotic cavities

MCMA - shared placenta, shared amniotic cavity

Conjoined

33
Q

What factor decides the form that monozygotic twins will develop in?

A

Point after fertilisation at which split occurs

34
Q

Which imaging technique can be used to determine the chorionicity of twins?

A

Ultrasound

35
Q

Which sign, found on ultrasound, can be used to differentiate DCDA and MCDA twins?

A

Lambda sign

Shows there are two placentas with a membrane between them

36
Q

Why is it important to know the zygosity and chorionicity of a twin pregnancy?

A

Different forms of twin pregnancy have different complication risks

37
Q

What is a possible symptom of multiple pregnancy?

A

Exaggerated morning sickness

38
Q

Which hormone maintains the corpus luteum during pregnancy?

A

hCG

39
Q

What happens to hCG levels during multiple pregnancy?

A

hCG levels are higher than normal

40
Q

Why is multiple pregnancy dangerous?

A

Increased risk of maternal and foetal complications

41
Q

Which dietary supplement is optional in most pregnant women but required in multiple pregnancy?

A

Iron

due to risk of anaemia

42
Q

Which anti-platelet is given to women with multiple pregnancy?

Why?

A

Aspirin

To reduce risk of pre-eclampsia

43
Q

Which dietary supplement is given to pregnant women to reduce the risk of their babies having neural tube defects?

A

Folic acid

44
Q

Which scan are women with multiple pregnancy regularly given?

A

Ultrasound scan

45
Q

What complication of monochorionic pregnancy results in one twin having polyhydramnios and the other having oligohydramnios?

A

Twin-twin transfusion syndrome

46
Q

Multiple pregnancies are often delivered by which method?

A

Caesarean section

47
Q

In what forms can a pregnant women have diabetes?

A

Either pre-existing Type 1, Type 2 diabetes or MODY

Or pregnancy-onset gestational diabetes

48
Q

What are the complications of poorly-controlled diabetes, no matter its form, in pregnant women?

A

Pre-eclampsia

Polyhydramnios

Macrosomia and shoulder dystocia

Neonatal hypoglycaemia

Miscarriage

49
Q

What are the common complications of diabetes which need to be monitored for in pregnant women?

A

Macrovascular disease

Microvascular disease - retinopathy, neuropathy, nephropathy

50
Q

What is the HbA1c target in pregnant women?

A

< 48 mmol/mol

51
Q

If a woman’s HbA1c is > ___ mmol/mol, they should avoid getting pregnant.

A

> 86 mmol/mol (or 10 units)

52
Q

Which folic acid dose are women given if they have pre-existing diabetes and want to get pregnant?

A

5mg

As opposed to 400 micrograms for everyone else

53
Q

The greater a pregnant woman’s ___, the greater her chances of developing diabetic complications.

A

greater HbA1c = greater complication risk

54
Q

Which drug are pregnant women given if they are at increased risk of vascular complications?

A

Aspirin

55
Q

What diseases does gestational diabetes increase a woman’s chances of developing post-partum?

A

Type 2 diabetes

Obesity

Cardiovascular disease

56
Q

Which test is used to diagnose gestational diabetes?

A

2h OGTT

57
Q

How is gestational diabetes managed?

A

Manage lifestyle (diet, exercise) as much as you can

Regular BG monitoring

Metformin OR Insulin injections / pump

58
Q

Which form of delivery avoids shoulder dystocia in macrosomic babies?

A

Caesarean section

59
Q

When is the target delivery gestation for women with pre-existing diabetes?

A

38 weeks

60
Q

How often do women with pre-existing diabetes receive foetal ultrasound scans during pregnancy?

A

Every 4 weeks from 28 weeks

Reproduction Week 3 2018/19 (8 decks)

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