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Large for Dates Flashcards

1
Q

What are the possible causes for a ‘LFD’ pregnancy?

A

Wrong dates
Multiple pregnancy
DM
Polyhydramnios

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2
Q

What is polyhydramnios?

A

Excess amniotic fluid

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3
Q

What are some causes of polyhydramnios?

A 
Monochorionic twin pregnancy
Fetal anomaly
Maternal diabetes
Hydrops fetalis – Rh isoimmunisation, infection (erythrovirus B19)
Ideopathic
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4
Q

What are some symptoms/complications of polyhydramnios?

A

Discomfort
Labour
Membrane rupture
Cord prolapse

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5
Q

How is polyhydramnios diagnosed?

A

US

Clinical

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6
Q

What are the incidences of spontaneous multiple pregnancies?

A

Twins 1:80

Triplets 1:10000

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7
Q

What is zygosity?

A

The number of eggs fertilised to produce twins

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8
Q

What is chorionicity?

A

The membrane pattern of the twins

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9
Q

What types of twins are at a higher risk of pregnancy complications?

A

Monochorionic/monozygous

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10
Q

What chorionicities can occur in monozygotic twins?

A

Monochorionic diamnotic ~2/3
Dichorionic diamnotic ~1/3
Monochorionic monoamniotic ~1%

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11
Q

What chorionicity occurs in dizygotic twins?

A

Dichorionic diamniotic

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12
Q

How can the chroionicity be discovered before birth?

A

US- shape of membrane and thickness of membrane: twin peak at 12 weeks

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13
Q

When is multiple pregnancy usually diagnosed?

A

12 weeks at US

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14
Q

What clinical features can indicate multiple pregnancy?

A

Exaggerated pregnancy symptoms e.g. excessive sickness
High AFP
Large for dates uterus
Feeling more than two fetal poles

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15
Q

Why does a multiple pregnancy have a much higher perinatal mortality?

A 
Congenital anomalies
Pre term labour
Growth restriction
Pre eclampsia
Antepartum haemorrhage
Twin to twin transfusion
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16
Q

How is a multiple pregnancy managed?

A 
More frequent antenatal visits
Detailed anomaly scan at 18wks
Regular scans from 28wks for growth
Routine iron supplementation
Warning to mother re risk and signs of pre term labour
17
Q

How is a multiple pregnancy delivered?

A

Twins- if twin one cephalic aim for SVD, possibly with epidural. Much greater risk for C-section (50%)
Triplets or more- C section

18
Q

What is the definition of GDM?

A

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

19
Q

What is the incidence and ethnic variation of GDM?

A

2-18%
South Asia, Middle Eastern
Black Caribbean

20
Q

What is the pathophysiology of GDM?

A

Placental hormones lead to relative insulin deficiency or resistance
Aberrant fuel mixture> glucose, aa’s and lipids
Enter placenta
Leads to hyperinsulinaemia

21
Q

What are the consequences of GDM?

A

Overgrowth of insulin sensitive tissues and macrosomia
Hypoxaemic state in utero
Short term metabolic complications
Fetal metabolic reprogramming leading to increase long term risk of obesity, insulin resistance and diabetes

22
Q

What screening is carried out for GDM?

A

Women screened for GTT based on RF’s or random blood glucose at booking and 28wks

23
Q

How is GDM diagnosed?

A

Based on GTT at 28wks
Fasting >5.1mmol/l
2 hour>=8.5mmol/l

24
Q

What are the risk factors for GDM?

A 
FHx of DM
Previous big baby
Previous unexplained still birth
Recurrently glycosuria
Maternal obesity
Previous GDM
25
Q

What complications occur in pregnancy due to pre-existing DM?

A

Congenital anomalies
Miscarriage
Intra uterine death

26
Q

What complications in pregnancy are common to pre-existing and GDM?

A 
Pre eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia
27
Q

What do all complications in pregnancy due to diabetes relate to?

A

Poor control

28
Q

What should target levels of glucose be in pregnancy?

A

Fasting 3.5-5.9mmol/l

1hr post prandial <7.8mmol/l

29
Q

What should initially be done in prevention of hyperglycaemia in pregnancy?

A

Diet
Wt control
Exercise

30
Q

When should hypoglycaemic therapy be used in pregnancy?

A

Diet and exercise fail to maintain targets

Macrosomia on US

31
Q

How is the choice of hypoglycaemic agent decided in pregnancy?

A

Tailored to glycaemic profile

Individual woman

32
Q

What are the advantages of oral hypoglycaemics in pregnancy?

A

Avoidance of hypoglycaemia associated with insulin
Less wt gain
Less education required to ensure safe/effective administration

33
Q

What specific obstetric care should be carried out in diabetes-related pregnancies?

A

Regular monitoring for PET
Growth: 2-4weekly FAC from 28wks or diagnosis
Fetal wellbeing: benefits of umbilical Doppler in high risk pregnancies and compared to CTG/BPP
Offer delivery from 38wks

34
Q

What has a 38wk delivery shown to improve in insulin dependent pregnancies?

A

Reduction in Macrosomia
No cases of shoulder dystocia
No significant difference in C-section rates

35
Q

What mode of delivery should be carried out in diabetes-related pregnancies?

A

Pregnant women with DM who have US diagnosed macrosomia should be informed of risks of vaginal birth and C-section
(Diabetes should not be a contraindication to attempting vaginal birth)

36
Q

What risk of developing T2DM do GDM mothers have?

A

Up to 70%

37
Q

What are the main risk factors for GDM mothers to develop T2DM?

A 
Obesity
Use of insulin during pregnancy
Fasting glucose levels from OGTT in pregnancy
IGT post partum
Ethnic group
38
Q

What lifestyle advice should women be offered post pregnancy who have IGT?

A

Diet, weight, exercise

Also have annual fasting blood glucose

39
Q

What general management should occur with pregnant mothers who have T1/T2DM?

A

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

Reproduction (40 decks)

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