Large for dates Flashcards
what is foetal macrosomia
big baby
what diagnoses foetal macrosomia
USS estimated foetal weight >90th centile
causes of large for date
diabetes polydramnios multiple pregnancy obesity foetal macrosomia
risks with large baby
dystocia - risk of shoulder getting stuck on way out of birth canal
what is polyhydramnios
excess amniotic fluid
causes of polyhydramnios
maternal diabetes foetal anomaly monochorionic twin pregnancy hyrops fetalis (Rh isoimmunisation, infection idiopathic
clinical features of polyhydramnios
abdo discomfort
pre-labour rupture of membranes (labour)
cord collapse
how to diagnose polyhydramnios
clinically
tense shiny abdomen
unable to feel foetal parts
what does ultrasound show
AFI >25
DVP >8
when should polyhydramnios patients have had an induction of labour by
40 weeks
what increases incidence of multiple pregnancy
assisted conception familial increased maternal age increased parity tall
what is monozygotic twins
share singular fertilized egg q
what is dizygotic twins
fertilization of 2 eggs by 2 sperm
what is more common, monozygotic or dizygotic twins
dizygotic
what is monozygous twins
separate sac and own placenta
NON-IDENTICAL
what is dizygous twins
share a sac and placenta
IDENTICAL
how do you determine chorionicity
USS - shape of membrane and thickness of membrane
12 weeks
mono - thinner T sign
di - thicker, lambda sign
what type of twins are at higher risk of complications
monochorionic monozygous
symptoms of multiple pregnancy
exaggerated pregnancy symptoms (hyperemesis)
investigations showing multiple pregnancy
high AFP
large for date uterus
multiple foetal poles
complications of multiple pregnancy to foetuses/neonates
perinatal mortality congenital anomalies intrauterine death pre-term birth growth restriction cerebral palsy twin-twin transfusion (polyhydramnios)
when should multiple pregnancy get a detailed congenital anomaly scan
18 weeks
maternal complications of multiple pregnancy
anaemia hyperemesis gravidarum pre-eclampsia antepartum haemorrhage pre-term labour C section
medications during pregnancy for multiple pregnancy
iron supplements
low dose aspirin
folic acid
mode of delivery for triplets or more
C section
how should twins be delivered if one has cephalic presentation
aim for vaginally
definition of gestational diabetes
carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
complications of pre-existing diabetes in pregnancy
congenital anomalies
miscarriage
intrauterine death
complications of both pre-existing and gestational diabetes
pre-eclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypoglycaemia
what medication should be stopped in diabetes pre-conception
ace inhibitors
cholesterol lowering agents
any other embryopathic meds
what medication should be given to diabetic patients in pregnancy
high dose folic acid - 3 months before conception to 12 weeks of pregnancy
low dose aspirin
risk factors for gestational diabetes
previous gestational diabetes obesity FH ethnicity previous big baby glycosuria
pathophysiology of gestational diabetes
hormones released from the placenta cause insulin deficiency/resistance
diagnostic criteria for gestational diabetes
fasting OGTT >=5.1
2 hour OGTT >=8.5
when should hypoglycaemic agents be considered in gestational diabetes
diet and exercise fail to maintain targets
macrosomia on USS
risk factors for postnatal development of type 2 diabetes
obesity
use of insulin during pregnancy
