FUNDUS GREATER THAN DATES Flashcards
Task
Your patient is a 26-year-old primigravida. She has been attending the general practice where you are working and
seeing the doctors there in a shared care arrangement with a specialist in a major city 30 km away. She is not due to
see the specialist again for a further six weeks. All appeared to be normal up to and including her last visit at 26 weeks
of gestation, when the symphysis-fundal height was 28 cm. Today, four weeks later at 30 weeks of gestation, the
symphysis-fundal height is 40 cm, and a weight gain of 6 kg has occurred during the four week time interval.
YOUR TASKS ARE TO:
* Take any further relevant history you require.
* Ask the examiner about the relevant findings on examination and the results of specific previous investigations
which you believe would have been performed.
* Advise the patient of the diagnosis and subsequent management.
questions to ask
-weight at start of pregnancy 56, and now 76
-DM
family hx, glycosuria during pregnancy, ogtt 26 normal?
-uss 18
single pregnancy, normal,
-pre-eclmepsa
headache, edema, visual disturbance
-blood group
rh positive, indirect coombs negative
-no hx fibroids
examination
-abdomen
fundal height 40. abdomen tense non tender
fluid thrill
-presentation
-fetal heart rate
-general exam bp, edema
ix
-blood grop, indirect coombs
-urine test today
-OGTT 26 weeks
-hb 26 weeks
-uss 18
explantion
-the larger uterus is porbably due to increase amniotic fluid, but this ha to be confirmed by USS to find the cause
-macrosomia : unlikely as glucose normal
-multiple gets : at 18wk USS
-fibroids, wrong dates, : USS 18 weeks
-dm : check anyway
-fetal anomalies : CNS, GIT, abdomen wall
chorioangioma placenta ; USS
-fetal infection : CMV, Toxo
complications
-premature labour, prom
-malpresentation
-placental abruption
advice
-as 30 weeks bed rest important
-premature delivery likely, attend early if suspect
-referral to consultant within few days
