Big for dates Flashcards
causes for large pregnancies
wrong dates
multiple preg
diabetes
polyhydramnios
what is polyhydramnios
what are the causes
excess amniotic fluid
monochorionic twins preg fetal anomaly maternal diabetes hydrops fetalis - Rh isoimmunisation infection idiopathic
what are the signs and symptoms of polyhydramnios
what is the diagnosis
discomfort, labour , membrane rupture, cord prolapse
US, clinical
multiple pregnancy incidence
where is there a higher incidence of multiple preg
spontaneous twins 1:80
triplets 1:10000
higher incidence in infertility programmes
what does zygosity mean
what does chrionicity mean
why are these terms important in multiple preg
zygosity refers to number of eggs fertilised to produce twins
c - refers to the membrane pattern of the twins
monochorionic/monozygous twins at higher risk of pregnancy complications
how can we tell chrionicity before birth
US
- shape of membrane and thickness of membrane - twin peak at 12 weeks
- fetal sex
Multiple pregnancy diagnosis
signs/symptoms
usually US at 12 weeks
exaggerated preg symptoms - excessive sickness
high AFP
large for dates uterus
feeling more than two fetal poles
multiple pregnancy complications
higher perinatal mortality due to congenital anomalies pre term labour growth restriction pre eclampsia antepartum haemorrhage twin to twin transfusion syndrome
multiple pregnancy manegemtns
more frequent antenatal visits detailed anomaly scan at 18 weeks regular scans from 28 weeks for growth routine iron supplementation warning to mother regarding risk and signs of pre term labour
multiple pregnancy delivery
triplets or more require a c section
twins - vaginal delivery
greater risk with c section
epidural analgesia
consequences of gestation diabetes
overgrowth of insulin sensitive tissues and macrosomia
hyperaemic state in utero
short term metabolic complications
fetal metabolic reprogramming leading to increase long term risk of obesity, insulin resistance and diabetes
gestational diabetes screening and dx
screened based on risk factors of random blood glucose at booking and 28 weeks gestation
dx based on GTT at 28 weeks
dx values fasting >=5.1
2 hour >=8.5
gestational diabetes risk factors
FH of DB previous big baby previous unexplained still birth recurrent glycosuria maternal obesity previous gestational diabetes
debates in preg - complications
all related to poor control
congenital anomalities, miscarriage, intra uterine death
pre eclampsia, polyhydramnios, macrosomia, shoulder dystocia, neonatal hypoglycaemia
target levels for mum
fasting 3.5-3.9
1 hour post prandial <7.8
