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Reproduction > Large For Dates > Flashcards

Large For Dates Flashcards

1
Q

What are the causes of large for dates?

A

wrong dates; fetal macrosomia; polyhydramnios; DM; multiple pregnnacy

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2
Q

What is fetal macrosomia defined as?

A

USS EFW >90th centile

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3
Q

What are the risks associated with fetal macrosomia?

A

labour dystocia; shoulder dystocia; PPH

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4
Q

What should be excluded with fetal macrosomia?

A

diabetes

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5
Q

What is polyhydramnios?

A

excess amniotic fluid

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6
Q

What are the causes of polyhydramnios?

A

maternal DM; fetal anomaly; monochorionic twin pregnnayc; hydrops fetalis; idiopathic

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7
Q

Why is common for late bookers to have wrong dates?

A

harder to accurately determine after the 1st trimester

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8
Q

What are the fetal anomalies implicated in polyhydramnios?

A

chromosomal; atresia; of oesophagus/duodenum/kidney

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9
Q

What is hydrops fetalis?

A

abdnormal accumulation of fluid in more than one fetal comprtaments

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10
Q

What are the clinical features of polyhydramnios?

A

abdo discomfort; prelabour rupture of membranes; preterm labour; cord prolapse

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11
Q

what are the clinical signs of polyhydramnia?

A

LFD; malpresentaiton; tense, shiny abdoment; inability to feel fetal parts

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12
Q

What is seen on USS with polyhydramnios?

A

AFI >25cm (amniotic fluid index); DVP >8cm (deepest vertical pool)

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13
Q

What investigations are done for polyhydramnios?

A

OGTT; serology- toxoplasmosis CMV; parvovirus; antibody screen; USS- fetal survey- lips, stomach

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14
Q

What are the risks of polyhydramnios in labour?

A

cord prolapse; preterm labour; PPH

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15
Q

When should polyhydramnios babies be induced by?

A

40 weeks

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16
Q

What is the incidence of twins?

A

1in 80

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17
Q

What is the incidence of triplets?

A

1 in 10,000

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18
Q

What race has highest risk of multiple pregnnacy?

A

African

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19
Q

What increases your chance of multiple prengnacy?

A

assisted conception; race; fhx; increased maternal age; parity; tall women> short women

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20
Q

What is a monozygotic pregnancy?

A

splitting of single fertilised egg

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21
Q

What is a dizygotic pregnnacy?

A

fertilisation of 2 ova by 2 sperm

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22
Q

What does chorionicity indicate?

A

1/2 placentas

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23
Q

What is the chorionicity of dizygous twins?

A

always dichorionic and diamniotic

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24
Q

What determines the chorionicity of monozygotic twins?

A

time of splitting of fertilised ovum

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25
Q

When does cleavage occur to give DCDA?

A

cleavage of morula days 1-3

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26
Q

When does cleavage occur to give MCDA?

A

blastocyst days 4-8

27
Q

When does cleavage occur to give MCMA?

A

implanted blastocyst days 8-13

28
Q

When does cleavage occur to give conjoined twins?

A

formed ambryonic disc days 15 +

29
Q

What is seen on USS with DCDA?

A

lambda sign

30
Q

What is seen on USS with MCDA?

A

T sign

31
Q

What are teh symtpoms of multiple pregnnacy?

A

exaggerated pregnnacy symtpoms eg hyperemesis gravidarum

32
Q

What are signs of mulitple prengnacy?

A

high AFP; large for dates; multiple fetal poles

33
Q

What is the risk of multiple pregnancy of perinatal mortality?

A

x6 than singleton

34
Q

What are the fetal complicatsion of multiple pregnancy?

A

congential anomalies; intra-uterine death; preterm birth; growth restriction; CP; twin to twin transfusion

35
Q

What are the maternal complicatiosn of multiple pregnnacy?

A

hyperemesis gravidarum; anaemia; pre-eclampsia; antepartum haemorrhage; preterm labour; C/s

36
Q

What medications are given to all multiple pregnancies?

A

iron supplements; low dose aspiring; folic acid

37
Q

What is the frequency of USS in MC multiple pregnancy?

A

2 weekly

38
Q

What is the frequency of USS in DC multiple pregnnacy?

A

4 weekly

39
Q

When should DCDA twins be delivered?

A

37-38 weeks

40
Q

when should MCDA twins be delivered ?

A

36 weeks

41
Q

What should be given after twin 1 is deliverd?

A

syntocinon

42
Q

What should the intertwin delivery time be?

A

<30mins

43
Q

What are the complications with pre-existing DM?

A

congenital anomalies; miscarriage; intra-uterine death

44
Q

what are congenital anomalies with pre-existing DM linked to?

A

high HBA1c at booking

45
Q

What are the complicatiosn of diabetes in pregnancy?

A

pre-eclampsia; polyhydramnios; macrosomia; shoulder dystocia; neonatal hypoglycaemia

46
Q

What dose of folic acid should be given to diabetics?

A

5mg folic acid

47
Q

Who should be given high dose folic acid(5mg)?

A

BMI >30; hx of neural tube defects; epileptics and diabetics

48
Q

Why should diabetics have regular eye checks during prengnayc?

A

retinopathjy can get worse in pregnancy

49
Q

How often should growth scans be done in diabetics from 28 weeks?

A

monthly

50
Q

What are the risk factors for devleoping GDM?

A

prev GDM; BMI >30; FHx; ethnic variation; prev big baby; polyhydramnios; glycosuria

51
Q

What are the consequences of GDM for the fetus?

A

overgrowth of insulin sensitive tissues and macrosomia; hypoxaemia statein utero; increased long term risk of obesity, insluin resistance and diabetes

52
Q

How is OGTT carried out?

A

venous FBS– 75g glucose; 2hr venous glucose

53
Q

What is the fasting value for GDM in scotalnd?

A

> 5.1mmol

54
Q

What is the 2hour value for GDM in scotland?

A

> 8.5mmol

55
Q

How often should women with GDM do their blood sugars?

A

minimum 4 timesday

56
Q

What is the target for fasting blood glucose?

A

3.5-5.9mmol/l

57
Q

What is the 1hour postprandial blood glucose target?

A

<7.8mmol

58
Q

What are the advantages of oral hypoglycaemia agents vs insiulin?

A

voidance of hypoglycaemia assoc. with insluin; less weight gain; less education needed

59
Q

When should those with GDM on insulin be delviered?

A

38 weeks

60
Q

Wehn should those on metformin with GDM be devliered?

A

39-40 weeks

61
Q

When should those on diet alone with GDM be delivered?

A

40-41 weeks

62
Q

Over what estimated fetal weight should C/S be carried out?

A

> 4.5kg

63
Q

What is the risk of T2DM after GDM?

A

upto 70%

64
Q

When should fasting blood sugars be done postnatally after GDM?

A

6-8 weks

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