Big babies Flashcards
commonest reason for large for date baby
obesity
what is large for date
Symphyseal-fundal height >2cm for Gestational age
risks of having a big baby
- clinican & maternal anxiety
- Labour dystocia
- Shoulder dystocia- more with diabetes
- PPH
management of a large for date baby
- exclude diabetes
- Reassure
- Conservative vs IOL vs C/S delivery
polyhydramnios definition
- excess amniotic fluid
- deepest pool >8cm
- Amniotic Fluid Index (AFI >25cm)
polyhydramnios causes
maternal:
- diabetes
- red cell antibodies
fetal:
- Anomaly: GI atresia, cardiac, tumours
- Monochorionic twin pregnancy
- Hydrops fetalis – Rh isoimmunisation
- Viral infection (erythrovirus B19, Toxoplasmosis, CMV)
Idiopathic
polyhydramnios clinical features
- abdominal discomfort
- preterm labour
- pre-labour rupture of membranes
- cord prolapse
polyhydramnios investigations
- OGTT
- viral serology
- antibody screen
- USS
what increases risk of multiple pregnancy?
Assisted conception
Race- African
Geography - Nigeria 40-50/1000 ( 1 in 25)deliveries
Family History
Increased maternal age
Increased Parity
Tall women> short women
are multiple pregnancies more likely to be monozygotic or dizygotic?
dizygotic
multiple pregnancy antenatal management
- Fe supplementation
- Low dose aspirin
- Folic acid
- USS - lots
What is Twin-To- Twin Transfusion Syndrome (TTTS)?
This happens when identical twins share a placenta (monochorionic). Abnormal blood vessel connections form in the placenta. They allow blood to flow unevenly between the fetuses.
what does monochorionic twins mean?
identical twins that share a placenta
diabetes in pregnancy complications
- pre-eclampsia
- polyhydramnios (too much amniotic fluid around the baby)
- macrosomia (big baby)
- shoulder dystocia
- neonatal hypoglycaemia
in diabetes, above what HBA1C level should pregnancy be avoided?
Above 86 mmol/mol
does insulin medication cross the placenta?
no
What is the difference between zygosity and Chorionicity?
Zygosity refers to the type of conception and the genetic makeup of the twins, while chorionicity refers to the type of placentation
