Large dates, pregnancy problems Flashcards
What are causes of the large baby?
Wrong dates
Multiple pregnancy
Diabetes
Polyhydramnios
What is the definition of Polyhydramnios?
Excess amniotic fluid
What can cause polyhydramnios?
monochorionic twin pregnancy
Maternal diabetes
Hydrops fetalis
Infection i.e. erythrovirus
What symptoms/complications arise from Polyhydramnios?
Discomfort
Labour
Membrane rupture
Cord prolapse
How is polyhydramnios diagnosed?
Ultrasound
Clinical
What is the incidence of twins and triplets?
Twins - 1:80
Triplets: 1:10,000
What does zygosity mean?
Number of eggs fertilised to produce twins
What does chorionicity mean?
Membrane pattern of the twins
Who is at a higher risk of pregnancy?
Monochorionic/Monozygous
How do you tell the chorionicity?
Ultrasound - shape of membrane and thickness of membrane, twin peak at 12 weeks
When are multiple pregnancies usually diagnosed?
12 weeks
What are the exaggerated symptoms of pregnancy?
Excessive sickness
High AFP
Large for dates uterus
Feeling more than two fetal poles
What complications are higher in multiple pregnancies?
Congenital anomalies Pre term labour Growth restrictions Pre eclampsia Antepartum haemorrhage Twin to twin transfusion
How do you manage multiple pregnancies?
Detailed anomaly scan at 18 weeks
Regular scans from 28 weeks for growth
Routine iron supplementation
Warning about higher risk of pre term labour
How do you deliver twins(or more)?
Caesarean section
What are the consequences of diabetes during pregnancy?
Overgrowth of insulin sensitive tissues and macrosomia
Hypoxaemic state in utero
Short term metabolic complications
Fetal metabolic reprogramming leading to increase long risk of obesity, insulin resistance and diabetes
What are the normal glucose levels?
Fasting - 5.1 mmol/l
2 hour - 8.5mmol/l
What are target glucose levels?
Fasting - 3.5-5.9mmol/l
1 hour post prandiol - 7.8mmol/l
When would you consider hypoglycaemic therapy?
When diet and exercise fail to maintain targets
Macrosomia on USS
What are additional managements for types 1 & 2 diabetes?
Pre pregnancy counselling
Fetal anomaly scan at 18 weeks
Regular eye checks for retinopathy
