large for dates

Question 1

wrong dates, multiple pregnancy, diabetes, poyhydramnios. causes of?

Answer 1

large for dates

Question 2

what is polyhydramnios?

Answer 2

excess amniotic fluid

Question 3

why do you get polyhydramnios?

Answer 3

monochorionic twin pregnancy, fetal anomaly, maternal diabetes, hydrops fetalis, idiopathic

Question 4

what is hydrops fetalis?

Answer 4

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.

Question 5

symptoms of polyhydramnios?

Answer 5

discomfort in labour, membrane rupture, cord prolapse

Question 6

how do you diagnose polyhydramnios?

Answer 6

ultrasound, clinical

Question 7

what has higher risk of complications? monochorionic or dichorionic?

Answer 7

monochorionic

Question 8

what is zygosisity?

Answer 8

number of eggs fertilised to produce twins

Question 9

what does chronicity refer to?

Answer 9

membrane pattern of the twins

Question 10

when are twins usually diagnosed?

Answer 10

booking visit

Question 11

excessive sickness, high AFP, large for dates uterus feeing more than 2 fetal poles?

Answer 11

twins

Question 12

twins have much higher perinatal mortality

Answer 12

y

Question 13

if triplets or more, how do you deliver

Answer 13

cs

Question 14

mutiple pregnancy, what do you do at 18 weeks?

Answer 14

detailed anomaly scan

Question 15

regular scans from 28 weeks for?

Answer 15

growth

Question 16

under what condition would you deliver twins by svd?

Answer 16

if one is cephalic

Question 17

what marker is raised in twins?

Answer 17

(eiff) AFP

Question 18

what is gestational diabetes?

Answer 18

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

Question 19

risk factors for gestational d?

Answer 19

previous big baby, previous unexplained stillirthh, recurrent glycosuria, maternal obesity, previous gd

Question 20

why does hyperinsulinaemia cause macrosomia?

Answer 20

insulin is a growth factor, causes overgrowth of insulin sestitive tissues

Question 21

can get miscarriage, intrauterine death, congenital anomalies

Answer 21

shoulder dystocia caused by macrosomia

Question 22

if mother has diabetes, increased risk of child having diabetes or obesity later on in life

Answer 22

y

Question 23

when is blood glucose tested in mother?

Answer 23

booking visit and 28 weeks

Question 24

what tests are done?

Answer 24

GTT /random glucose

Question 25

what is diagnosis based on ?

Answer 25

GTT at 28 weeks

Question 26

what are the cut offs?

Answer 26

fasting >5.1 m mol/l

2 hour >8.5 mol/l

Question 27

blood glucose targets?

Answer 27

fasting 3.5 - 5.9

one hour post prandial less than 7.8

Question 28

pathophysiology of macrosomia?

Answer 28

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.

Question 29

why do you get increased risk of obesity and diabetes?

Answer 29

fetal metabolic reprogramming leads to long term increased risk

Question 30

why do you get neonatal hypoglycaemia?

Answer 30

hyperinsulinaemia

Question 31

GDM - how do you prevent hyperglycaemia?

Answer 31

diet, weight control, exercise

Question 32

when do you consider hypoglycaemia therapy?

Answer 32

when diet and exercise fail to maintain targets/macrosomia on US

Question 33

advantages of oral hypoglycaemic over insulin>

Answer 33

avoid hypo, less weight gain, less education required

Question 34

for gestational diabetes, when do you offer delivery?

Answer 34

from 38 weeks gestation*****

Question 35

there is a benefit of doing umbilical dopplers in ?

Answer 35

high risk pregnancies to assess metal wellbeing

Question 36

is diabetes a risk to attempting vaginal birth?

Answer 36

no