large for dates Flashcards
wrong dates, multiple pregnancy, diabetes, poyhydramnios. causes of?
large for dates
what is polyhydramnios?
excess amniotic fluid
why do you get polyhydramnios?
monochorionic twin pregnancy, fetal anomaly, maternal diabetes, hydrops fetalis, idiopathic
what is hydrops fetalis?
Hydrops fetalis (fetal hydrops) is a serious fetal condition defined as abnormal accumulation of fluid in 2 or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin edema.
symptoms of polyhydramnios?
discomfort in labour, membrane rupture, cord prolapse
how do you diagnose polyhydramnios?
ultrasound, clinical
what has higher risk of complications? monochorionic or dichorionic?
monochorionic
what is zygosisity?
number of eggs fertilised to produce twins
what does chronicity refer to?
membrane pattern of the twins
when are twins usually diagnosed?
booking visit
excessive sickness, high AFP, large for dates uterus feeing more than 2 fetal poles?
twins
twins have much higher perinatal mortality
y
if triplets or more, how do you deliver
cs
mutiple pregnancy, what do you do at 18 weeks?
detailed anomaly scan
regular scans from 28 weeks for?
growth
under what condition would you deliver twins by svd?
if one is cephalic
what marker is raised in twins?
(eiff) AFP
what is gestational diabetes?
carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset of first recognition during pregnancy
risk factors for gestational d?
previous big baby, previous unexplained stillirthh, recurrent glycosuria, maternal obesity, previous gd
why does hyperinsulinaemia cause macrosomia?
insulin is a growth factor, causes overgrowth of insulin sestitive tissues
can get miscarriage, intrauterine death, congenital anomalies
shoulder dystocia caused by macrosomia
if mother has diabetes, increased risk of child having diabetes or obesity later on in life
y
when is blood glucose tested in mother?
booking visit and 28 weeks
what tests are done?
GTT /random glucose
what is diagnosis based on ?
GTT at 28 weeks
what are the cut offs?
fasting >5.1 m mol/l
2 hour >8.5 mol/l
blood glucose targets?
fasting 3.5 - 5.9
one hour post prandial less than 7.8
pathophysiology of macrosomia?
placental hormones like HCS and CRH** cause insulin deficiency/insulin resistance. this leads to increase in fuel mixture, which cross the placenta and lead to hyperinsulinaemia. overgrowth of tissues and macrosomia. hyperaemic state in utero. short term metabolic complications.
why do you get increased risk of obesity and diabetes?
fetal metabolic reprogramming leads to long term increased risk
why do you get neonatal hypoglycaemia?
hyperinsulinaemia
GDM - how do you prevent hyperglycaemia?
diet, weight control, exercise
when do you consider hypoglycaemia therapy?
when diet and exercise fail to maintain targets/macrosomia on US
advantages of oral hypoglycaemic over insulin>
avoid hypo, less weight gain, less education required
for gestational diabetes, when do you offer delivery?
from 38 weeks gestation*****
there is a benefit of doing umbilical dopplers in ?
high risk pregnancies to assess metal wellbeing
is diabetes a risk to attempting vaginal birth?
no
