Large For Dates Flashcards
What are the causes of large for dates?
wrong dates; fetal macrosomia; polyhydramnios; DM; multiple pregnnacy
What is fetal macrosomia defined as?
USS EFW >90th centile
What are the risks associated with fetal macrosomia?
labour dystocia; shoulder dystocia; PPH
What should be excluded with fetal macrosomia?
diabetes
What is polyhydramnios?
excess amniotic fluid
What are the causes of polyhydramnios?
maternal DM; fetal anomaly; monochorionic twin pregnnayc; hydrops fetalis; idiopathic
Why is common for late bookers to have wrong dates?
harder to accurately determine after the 1st trimester
What are the fetal anomalies implicated in polyhydramnios?
chromosomal; atresia; of oesophagus/duodenum/kidney
What is hydrops fetalis?
abdnormal accumulation of fluid in more than one fetal comprtaments
What are the clinical features of polyhydramnios?
abdo discomfort; prelabour rupture of membranes; preterm labour; cord prolapse
what are the clinical signs of polyhydramnia?
LFD; malpresentaiton; tense, shiny abdoment; inability to feel fetal parts
What is seen on USS with polyhydramnios?
AFI >25cm (amniotic fluid index); DVP >8cm (deepest vertical pool)
What investigations are done for polyhydramnios?
OGTT; serology- toxoplasmosis CMV; parvovirus; antibody screen; USS- fetal survey- lips, stomach
What are the risks of polyhydramnios in labour?
cord prolapse; preterm labour; PPH
When should polyhydramnios babies be induced by?
40 weeks
What is the incidence of twins?
1in 80
What is the incidence of triplets?
1 in 10,000
What race has highest risk of multiple pregnnacy?
African
What increases your chance of multiple prengnacy?
assisted conception; race; fhx; increased maternal age; parity; tall women> short women
What is a monozygotic pregnancy?
splitting of single fertilised egg
What is a dizygotic pregnnacy?
fertilisation of 2 ova by 2 sperm
What does chorionicity indicate?
1/2 placentas
What is the chorionicity of dizygous twins?
always dichorionic and diamniotic
What determines the chorionicity of monozygotic twins?
time of splitting of fertilised ovum
When does cleavage occur to give DCDA?
cleavage of morula days 1-3
When does cleavage occur to give MCDA?
blastocyst days 4-8
When does cleavage occur to give MCMA?
implanted blastocyst days 8-13
When does cleavage occur to give conjoined twins?
formed ambryonic disc days 15 +
What is seen on USS with DCDA?
lambda sign
What is seen on USS with MCDA?
T sign
What are teh symtpoms of multiple pregnnacy?
exaggerated pregnnacy symtpoms eg hyperemesis gravidarum
What are signs of mulitple prengnacy?
high AFP; large for dates; multiple fetal poles
What is the risk of multiple pregnancy of perinatal mortality?
x6 than singleton
What are the fetal complicatsion of multiple pregnancy?
congential anomalies; intra-uterine death; preterm birth; growth restriction; CP; twin to twin transfusion
What are the maternal complicatiosn of multiple pregnnacy?
hyperemesis gravidarum; anaemia; pre-eclampsia; antepartum haemorrhage; preterm labour; C/s
What medications are given to all multiple pregnancies?
iron supplements; low dose aspiring; folic acid
What is the frequency of USS in MC multiple pregnancy?
2 weekly
What is the frequency of USS in DC multiple pregnnacy?
4 weekly
When should DCDA twins be delivered?
37-38 weeks
when should MCDA twins be delivered ?
36 weeks
What should be given after twin 1 is deliverd?
syntocinon
What should the intertwin delivery time be?
<30mins
What are the complications with pre-existing DM?
congenital anomalies; miscarriage; intra-uterine death
what are congenital anomalies with pre-existing DM linked to?
high HBA1c at booking
What are the complicatiosn of diabetes in pregnancy?
pre-eclampsia; polyhydramnios; macrosomia; shoulder dystocia; neonatal hypoglycaemia
What dose of folic acid should be given to diabetics?
5mg folic acid
Who should be given high dose folic acid(5mg)?
BMI >30; hx of neural tube defects; epileptics and diabetics
Why should diabetics have regular eye checks during prengnayc?
retinopathjy can get worse in pregnancy
How often should growth scans be done in diabetics from 28 weeks?
monthly
What are the risk factors for devleoping GDM?
prev GDM; BMI >30; FHx; ethnic variation; prev big baby; polyhydramnios; glycosuria
What are the consequences of GDM for the fetus?
overgrowth of insulin sensitive tissues and macrosomia; hypoxaemia statein utero; increased long term risk of obesity, insluin resistance and diabetes
How is OGTT carried out?
venous FBS– 75g glucose; 2hr venous glucose
What is the fasting value for GDM in scotalnd?
> 5.1mmol
What is the 2hour value for GDM in scotland?
> 8.5mmol
How often should women with GDM do their blood sugars?
minimum 4 timesday
What is the target for fasting blood glucose?
3.5-5.9mmol/l
What is the 1hour postprandial blood glucose target?
<7.8mmol
What are the advantages of oral hypoglycaemia agents vs insiulin?
voidance of hypoglycaemia assoc. with insluin; less weight gain; less education needed
When should those with GDM on insulin be delviered?
38 weeks
Wehn should those on metformin with GDM be devliered?
39-40 weeks
When should those on diet alone with GDM be delivered?
40-41 weeks
Over what estimated fetal weight should C/S be carried out?
> 4.5kg
What is the risk of T2DM after GDM?
upto 70%
When should fasting blood sugars be done postnatally after GDM?
6-8 weks
