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Reproduction & Sexual Health > Large for Dates > Flashcards

Large for Dates Flashcards

1
Q

Define large for dates

A

Symphyseal-fundal height >2cm for gestational age

Estimated foetal weight >90th centile

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2
Q

State five causes for large for dates

A
  • wrong dates
  • foetal macrosomia
  • polydramnios
  • diabetes
  • multiple pregnancy
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3
Q

What does an USS of foetal macrosomia show?

A

Estimated foetal weight >90th centile

Abdominal circumference >97th centile

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4
Q

How is foetal macrosomia managed?

A

Exclude diabetes
Reassure
Conservative/induction/C-section

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5
Q

What are the NICE guidelines for delivery of macrosomic babies?

A

Absence of other indications do not induce labour purely because of macrosomia

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6
Q

What are the risks of macrosomia?

A 
Dr/maternal anxiety 
Labour dystocia 
Shoulder dystocia 
Diabetes 
Post-partum haemorrhage
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7
Q

What is the name for excess amniotic fluid?

A

Polyhydramios

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8
Q

How is excess amniotic fluid quantified?

A

Amniotic fluid index >25cm

Deepest pool >8cm

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9
Q

What can cause polyhydramios?

A

Maternal - diabetes
Foetal
- anomaly - GI atresia, cardiac, tumours
- monochorionic twin pregnancy
- hydros fetalis
- viral infection (toxoplasmosis, CMV, erythrovirus B19)

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10
Q

What are the symptoms of polyhydramios?

A

Abdominal discomfort
Pre-labour rupture of membranes
Preterm labour
Cord prolapse

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11
Q

What are the signs of polyhydramios?

A

Large for dates
Malpresentation
Shiny, tense abdomen
Inability to feel foetal parts

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12
Q

How is polyhydramios diagnosed?

A

Ultrasound - AFI >25cm, DVP >8cm

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13
Q

What are the investigations for polyhydramios?

A

Oral glucose tolerance test
Serology (toxoplasmosis, CMV, parvovirus)
Antibody screen
USS - foetal survey

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14
Q

How is polyhydramios managed?

A

Induce labour by 40 weeks

Serial USS to assess growth, presentation

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15
Q

What are the labour risks of polyhydramios?

A

Risk of malpresentation
Cord prolapse
Preterm labour
PPH

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16
Q

Define multiple pregnancy

A

Presence of more than one foetus

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17
Q

What are the risk factors for multiple pregnancy?

A 
Assisted conception 
African 
Geography 
Family History 
Increased maternal age 
Increased parity 
Tall women
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18
Q

Define zygosity

A

Whether the foetus’ have developed from a single ovum or different ova

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19
Q

What is the difference between monozygosity and dizygosity?

A

Mono - splitting of a single fertilised egg

Di - fertilisations of two ova by two spermatozoa

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20
Q

Define chrionicity

A

Number of placenta

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21
Q

Name the four variations of monozygosity

A

Dichorionic diamnitoic
Monochorionic diamniotic
Monochorionic monoamnitoic
Conjoined twins

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22
Q

What chorionicity is dizygous always?

A

Dichorionic diamniotic

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23
Q

When can chorionicity and zygosity be determined?

A

Shape and thickness of membrane at booking scan

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24
Q

What two signs can be seen on ultrasound to determine the chorionicity?

A

Lamdba - di

T sign - mono

25
Q

What type of twins are at higher risk?

A

Monochorionic/monozygous

26
Q

What are the signs/symptoms of multiple pregnancy?

A

Exaggerated pregnancy symptoms

Signs - high AFP, large for dates uterus, multiple fetal poles

27
Q

State the fetal complications of multiple pregnancy

A

Congenital anomalies, intrauterine death, preterm birth, growth restriction, cerebral palsy, twin to twin trasfusion

28
Q

State the maternal complications of multiple pregnancy

A 
Hyperemesis gravidarum
Anaemia 
Pre-eclampsia 
C-section 
Antepartum haemorrhage 
Diabetes
29
Q

What medications should be given to patients with multiple pregnancy?

A

Iron supplements, low dose aspirin, folic acid

30
Q

How many ultrasounds will a multiple pregnancy patient have?

A

MC - 2 weekly from 16 weeks

DC 4 weekly

31
Q

If the pregnancy is monochorionic monoamniotic what is the management?

A

Deliver by c-section at 32-34 weeks

32
Q

State the complications of monochorionic twins

A
  • single fetal death
  • selective growth restriction
  • twin anaemia polycythaemia
  • absent/reversed end diastolic flow
  • twin to twin transfusion
33
Q

How is single fetal death managed?

A

MRI 4 weeks post IUD and MCA US to check for fetal anaemia. Risk of death and neurological abnormality to the survivor are high.

34
Q

If abnormal doppler is found on selective growth restriction what may be required?

A

Selective reduction

35
Q

What is twin anaemia polycythaemia sequence?

A

Imbalance in blood levels between the two babies

36
Q

What can cause twin anaemia polycythaemia sequence?

A

Spontaneously

Following laser ablation for TTTS

37
Q

How is twin anaemia polycythaemia sequence diagnosed?

A

US of middle cerebral artery peak systolic velocity

38
Q

Define twin to twin transfusion syndrome

A

Syndrome with artery-vein anastomoses, donor twin perfuses the recipient twin

39
Q

How is twin to twin transfusion diagnosed?

A

Oligohydramios - donor

Polyhydramios - recipient

40
Q

What are the complications of twin to twin transfusion?

A

Mortality >90% with no treatment

Neurological morbidity

41
Q

How is twin to twin transfusion treated?

A

<26/40 weeks fetoscopic last ablation

>26/40 weeks amnioreduction/septostomy

42
Q

When should babies with twin to twin transfusion be delivered?

A

34-36 weeks

43
Q

What is the risk of C-section in multiple pregnancy?

A

50% greater risk of c-section

44
Q

What are the indications for c-section in multiple pregnancy?

A

MCMA

Triplets or more

45
Q

Describe labour in multiple pregnancy

A 
Epidural 
Fetal monitoring (USS,FSE)
Synthetic oxytocin after twin 1 
USS for presentation 
<30 mins between deliveries
46
Q

Define gestational diabetes

A

Carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset/first recognition during pregnancy

47
Q

What are the fetal complications of maternal diabetes?

A

Congenital anomalies, miscarriage, IUD, worsening diabetic complications, pre-eclampsia, polyhydramios, macrosomia, shoulder dystocia, neonatal hypoglycaemia

48
Q

How is T1/T2 DM managed in pregnancy?

A

Low dose aspirin from 12 weeks
Fetal anomaly scan 18-20weeks
Growth scan 4 weekly
Deliver at 38 weeks

49
Q

What are the risk factors for gestational diabetes?

A 
Previous GDM (50% recurrence)
BMI >30
Family history - mum or sister 
Ethnic variation 
Previous big baby
Big baby
Glycosuria
50
Q

Describe the pathogenesis of gestational diabetes

A

HPL and cortisol cause placental hormones to induce insulin resistance/deficiency causing overgrowth of sensitive tissues

51
Q

How is gestational diabetes investigated?

A

BG monitoring, OGTT 24-28 weeks

52
Q

What is the diagnostic fasting and 2 hour glucose for gestational diabetes?

A

Fasting >5.1/5.6

2 hour >8.5/7.8

53
Q

What are the target values for fasting glucose and 1 hour?

A

Fasting 3.5-5.5

1 hour <7.8

54
Q

What does delivery date depend on in diabetics?

A

Management

55
Q

Describe the different delivery dates for diabetics

A

Insulin 38-39 weeks
Metformin 39-40 weeks
Diet 40-41 weeks
Macrosomia/PET/IUGR - earlier delivery

56
Q

When is a c-section indicated in diabetes?

A

EFW >4.5kg

57
Q

What is the risk of post natal T2DM after gestational diabetes?

A

Up to 70%

58
Q

What are the risk factors for post natal T2DM?

A

Obesity, use of insulin in pregnancy, ethnic group, OGTT fasting levels, IGT post partum

59
Q

When are bloods checked post natally?

A

6-8 weeks fasting/OGTT

Reproduction & Sexual Health (36 decks)

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