Large for dates

Question 1

Why might a baby be large for dates? (4)

Answer 1

Wrong dates
Multiple pregnancies
DM
Polyhydramnios

Question 2

polyhydramnios

• definition?
• causes? (5)
• symptoms? (4)
• Dx? (2)

Answer 2

-excess amniotic fluid

-monochorionic twins
foetal anomoly
maternal DM
Hydrops fetalis
idiopathic 

-Discomfort
premature Labour (uterus stretched)
Membrane rupture
cord prolapse

-US + clinical

Question 3

Multiple pregnancy

• what are Chorionicity & zygosity?
• what pattern means twins are at higher risk of complications?
• how can you asses chorionicity?
• symptoms of multiple pregnancy? (4)
• complications? (6)
• Management (4)
• delivery?

Answer 3

Chorionicity
membrane pattern of twins
can be dichorionic/monochorionic 
Zygosity
no. of eggs fertilised can be monovular (1 ova, 1 sperm)
binovular (2 ova, 2 sperm)

• Monochorionic/monozygous
• US, at 12 weeks

-exaggerated pregnancy symptoms (excessive sickness)
High AFP
Large for dates uterus
feeling more than 2 foetal poles

-Congenital anomalies
Pre term labour
Growth restriction
Pre eclampsia
Antepartum haemorrhage
Twin to twin transfusion syndrome

-More frequent antenatal visits
Detailed anomaly scan at 18 wks
regular scans from 28 wks to asses growth
warn re complications

-triplets+ aim for C section
twins- vaginal delivery if one cephalic
epidural anaesthesia

Question 4

Diabetes in pregnancy 
-describe pathogenesis of GDM?
-consequences of this?
-screening?
-Dx? (2)
-what are the risk factors? (6)
-complications:
pre-existing(3)
pre-existing & gestational (5)
-management:
-first step?
-what drugs used- benefits? (3)
-monitering & delivery? (2)

Answer 4

-placental hormones lead to relative insulin deficiency and insulin resistance
+ beta cell dysfunction leading to hyperinsulinaemia

• macrosmia (shoulder dystocia)
  Hyperaemic state in utero
  short term metabolic complications
  increased risk of obesity & DM

-random Blood glucose at booking and 28 weeks

-based on glucose tolerance test at 28 weeks
Fasting > = 5.1 mol/l
2 hour >= 8.5mmol/l

-fam hx DM
Prev big baby
prev unexplained stillbirth 
recurrent glycosuria
maternal obesity
Prev gestational DM

-pre-existing
congenital anomalies
Miscarriage
intra uterine death

pre-existing + GDM
pre-eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia 
Neonatal hypoglycaemia 

-education in terms of lifestyle, risks and glycemic control
initial approach is: Diet, weight control, exercise

Oral hypoglycaemics or insulin 
oral ones:
avoid hypos you get with insulin 
less weight gain
less education for administration 

-regular monitering, lok at growth 2-4 weekly
offer delivery from 38 wks gestation