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Repro HK > Large for dates > Flashcards

Large for dates Flashcards

1
Q

what is foetal macrosomia

A

big baby

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2
Q

what diagnoses foetal macrosomia

A

USS estimated foetal weight >90th centile

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3
Q

causes of large for date

A 
diabetes
polydramnios 
multiple pregnancy 
obesity 
foetal macrosomia
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4
Q

risks with large baby

A

dystocia - risk of shoulder getting stuck on way out of birth canal

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5
Q

what is polyhydramnios

A

excess amniotic fluid

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6
Q

causes of polyhydramnios

A 
maternal diabetes 
foetal anomaly 
monochorionic twin pregnancy 
hyrops fetalis (Rh isoimmunisation, infection
idiopathic
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7
Q

clinical features of polyhydramnios

A

abdo discomfort
pre-labour rupture of membranes (labour)
cord collapse

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8
Q

how to diagnose polyhydramnios

A

clinically
tense shiny abdomen
unable to feel foetal parts

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9
Q

what does ultrasound show

A

AFI >25

DVP >8

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10
Q

when should polyhydramnios patients have had an induction of labour by

A

40 weeks

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11
Q

what increases incidence of multiple pregnancy

A 
assisted conception
familial 
increased maternal age 
increased parity 
tall
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12
Q

what is monozygotic twins

A

share singular fertilized egg q

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13
Q

what is dizygotic twins

A

fertilization of 2 eggs by 2 sperm

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14
Q

what is more common, monozygotic or dizygotic twins

A

dizygotic

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15
Q

what is monozygous twins

A

separate sac and own placenta

NON-IDENTICAL

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16
Q

what is dizygous twins

A

share a sac and placenta

IDENTICAL

17
Q

how do you determine chorionicity

A

USS - shape of membrane and thickness of membrane
12 weeks
mono - thinner T sign
di - thicker, lambda sign

18
Q

what type of twins are at higher risk of complications

A

monochorionic monozygous

19
Q

symptoms of multiple pregnancy

A

exaggerated pregnancy symptoms (hyperemesis)

20
Q

investigations showing multiple pregnancy

A

high AFP
large for date uterus
multiple foetal poles

21
Q

complications of multiple pregnancy to foetuses/neonates

A 
perinatal mortality 
congenital anomalies 
intrauterine death 
pre-term birth 
growth restriction
cerebral palsy 
twin-twin transfusion (polyhydramnios)
22
Q

when should multiple pregnancy get a detailed congenital anomaly scan

A

18 weeks

23
Q

maternal complications of multiple pregnancy

A 
anaemia 
hyperemesis gravidarum 
pre-eclampsia 
antepartum haemorrhage 
pre-term labour 
C section
24
Q

medications during pregnancy for multiple pregnancy

A

iron supplements
low dose aspirin
folic acid

25
Q

mode of delivery for triplets or more

A

C section

26
Q

how should twins be delivered if one has cephalic presentation

A

aim for vaginally

27
Q

definition of gestational diabetes

A

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

28
Q

complications of pre-existing diabetes in pregnancy

A

congenital anomalies
miscarriage
intrauterine death

29
Q

complications of both pre-existing and gestational diabetes

A 
pre-eclampsia 
polyhydramnios
macrosomia 
shoulder dystocia
neonatal hypoglycaemia
30
Q

what medication should be stopped in diabetes pre-conception

A

ace inhibitors
cholesterol lowering agents
any other embryopathic meds

31
Q

what medication should be given to diabetic patients in pregnancy

A

high dose folic acid - 3 months before conception to 12 weeks of pregnancy
low dose aspirin

32
Q

risk factors for gestational diabetes

A 
previous gestational diabetes
obesity
FH 
ethnicity 
previous big baby
glycosuria
33
Q

pathophysiology of gestational diabetes

A

hormones released from the placenta cause insulin deficiency/resistance

34
Q

diagnostic criteria for gestational diabetes

A

fasting OGTT >=5.1

2 hour OGTT >=8.5

35
Q

when should hypoglycaemic agents be considered in gestational diabetes

A

diet and exercise fail to maintain targets

macrosomia on USS

36
Q

risk factors for postnatal development of type 2 diabetes

A

obesity

use of insulin during pregnancy

Repro HK (37 decks)

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