Large for dates Flashcards
What is a large for date baby
Weight of the newborn is more than4.5kg at birth; during pregnancy, anestimated fetal weightabove the90th centileis considered large for gestational age
What symphyseal-fundal heigh is classified as large for date
> 2cm above average
How is symphyseal-fundal height measured and mapped to gestation
First measurable at 12 weeks
At 20 weeks, should match with gestational age (E.g. 20cm = 20 weeks gestation)
Measuring tape from pubic symphysis to fundus
Causes of large for date babies
- Wrong dates
- Foetal macrosomia
- Polyhydramnios
- Maternal diabetes
- Multiple pregnancy
- Maternal obesity
- Uterine conditions (E.g. fibroids)
Effects of pregnancy on diabetes
- Increases insulin requirements
- N+V can precipitate DKA
- Ketosis more common
- Diabetic retinopathy worsents especially after rapid control of diabetes
- Diabetic nephropathy can worsen
Causes of wrong dates
Late booker
Concealed pregnancy
Vulnerable women (Hiding pregnancy from partner)
Transfer of care from abroad
Management of foetal macrosomia
Exclude diabetes
Reassure
Conservative vs IOL vs C-section delivery
Management of polyhydramnios
IOL by 40 weeks
Neonatal examination
Pre-pregnancy counselling in maternal diabetes
- HbA1c 48 mmol/mol
- Stop embryopathic medication
- High dose folic acid 5mg (3 months before conception to 12 weeks of pregnancy)
Antenatal management of maternal diabetes
- Screen for complications
- Counsel about shoulder dystocia risk
- Deliver by 38+6/40 (type 1 and 2), earlier if complications
Post-natal management of T2DM
Revert to pre-pregnancy treatment
Post-natal management of T1DM
Pre-pregnancy insulin doses
Breastfeeding can cause hypoglycaemia so caution
Complications of foetal macrosomia (Big baby)
- Clinician and maternal anxiety
- Labour dystocia
- Shoulder dystocia (more with diabetes)
- PPH
