Large for Dates

Question 1

What is polyhydramnios?

Answer 1

excess amniotic fluid

Question 2

What can cause polyhydramnios?

Answer 2

idiopathic 
monochorionic twins 
hydrops fetalis
maternal diabetes 
fetal anomoly

Question 3

What are the symptoms of polyhydramnios?

Answer 3

large for dates
discomfort
?labour

Question 4

What are the complications of polyhydramnios?

Answer 4

membrane rupture

cord prolapse

Question 5

How is polyhydramnios diagnosed and treated?

Answer 5

USS, clinical diagnosis

extra antenatal appointments and regular USS

Question 6

What does zygosity mean?

Answer 6

number of eggs fertilised

Question 7

What does chorionicity mean?

Answer 7

membrane pattern

e.g. monochorionic is 1 placenta shared

Question 8

What are predisposing factors to multiple pregnancy?

Answer 8

previous twins
family history
increased maternal age
IVF

Question 9

How does a multiple pregnancy present?

Answer 9

uterus large for dates 
hyperemesis 
polyhydramnios 
>2 poles felt
2 fetal heart rates

Question 10

How is multiple pregnancy diagnosed?

Answer 10

USS

high AFP

Question 11

What are some complications of multiple pregnancy?

Answer 11

all the risks of pregnancy are increased 
polyhydramnios 
pre eclampsia 
anaemia 
ante partum haemorrhage 
pre term labour and prematurity

Question 12

How is a multiple pregnancy treated?

Answer 12

more frequent antenatal visits
regular scanning
delivery - high risk of needing a c section

Question 13

What is gestational diabetes?

Answer 13

increased blood glucose that develops during pregnancy

Question 14

How many people develop type 2 diabetes after gestational diabetes?

Answer 14

50%

Question 15

What are risk factors for gestational diabetes?

Answer 15

previous GDM 
first degree relative 
previous baby >4.5kg 
obesity 
ethnicity

Question 16

How does gestational diabetes present?

Answer 16

uterus large for dates

Question 17

How is gestational diabetes diagnosed?

Answer 17

fasting: >5.6mmol/l

2 hour: >7.8mmol/l

Question 18

What are the complications of gestational diabetes?

Answer 18

all relate to poor control 
pre eclampsia 
shoulder dystocia 
macrosomia 
neonatal hypoglycaemia 
polyhydramnios

Question 19

What is the treatment of gestational diabetes?

Answer 19

lifestyle advice - diet, exercise
target BG levels - fasting 3.5-5.9, 1 hour post prandial <7.8
if after 1-2 weeks uncontrolled with diet and exercise - metformin, glibenclamide
insulin