Large dates, pregnancy problems

Question 1

What are causes of the large baby?

Answer 1

Wrong dates
Multiple pregnancy
Diabetes
Polyhydramnios

Question 2

What is the definition of Polyhydramnios?

Answer 2

Excess amniotic fluid

Question 3

What can cause polyhydramnios?

Answer 3

monochorionic twin pregnancy
Maternal diabetes
Hydrops fetalis
Infection i.e. erythrovirus

Question 4

What symptoms/complications arise from Polyhydramnios?

Answer 4

Discomfort
Labour
Membrane rupture
Cord prolapse

Question 5

How is polyhydramnios diagnosed?

Answer 5

Ultrasound

Clinical

Question 6

What is the incidence of twins and triplets?

Answer 6

Twins - 1:80

Triplets: 1:10,000

Question 7

What does zygosity mean?

Answer 7

Number of eggs fertilised to produce twins

Question 8

What does chorionicity mean?

Answer 8

Membrane pattern of the twins

Question 9

Who is at a higher risk of pregnancy?

Answer 9

Monochorionic/Monozygous

Question 10

How do you tell the chorionicity?

Answer 10

Ultrasound - shape of membrane and thickness of membrane, twin peak at 12 weeks

Question 11

When are multiple pregnancies usually diagnosed?

Answer 11

12 weeks

Question 12

What are the exaggerated symptoms of pregnancy?

Answer 12

Excessive sickness
High AFP
Large for dates uterus
Feeling more than two fetal poles

Question 13

What complications are higher in multiple pregnancies?

Answer 13

Congenital anomalies
Pre term labour
Growth restrictions
Pre eclampsia
Antepartum haemorrhage
Twin to twin transfusion

Question 14

How do you manage multiple pregnancies?

Answer 14

Detailed anomaly scan at 18 weeks
Regular scans from 28 weeks for growth
Routine iron supplementation
Warning about higher risk of pre term labour

Question 15

How do you deliver twins(or more)?

Answer 15

Caesarean section

Question 16

What are the consequences of diabetes during pregnancy?

Answer 16

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

Question 17

What are the normal glucose levels?

Answer 17

Fasting - 5.1 mmol/l

2 hour - 8.5mmol/l

Question 18

What are target glucose levels?

Answer 18

Fasting - 3.5-5.9mmol/l

1 hour post prandiol - 7.8mmol/l

Question 19

When would you consider hypoglycaemic therapy?

Answer 19

When diet and exercise fail to maintain targets

Macrosomia on USS

Question 20

What are additional managements for types 1 & 2 diabetes?

Answer 20

Pre pregnancy counselling
Fetal anomaly scan at 18 weeks
Regular eye checks for retinopathy