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Repro and Sexual Health > Large for dates > Flashcards

Large for dates Flashcards

1
Q

What is the definition for a large for date baby?

A

Symphyseal fundal height >2cm for gestational age

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2
Q

What are the causes for large for date babies?

A 
Wrong EDD
Foetal macrosomia
Polyhydramnios
Diabetic mother
Multiple pregnancy
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3
Q

How is foetal macrosomia diagnosed?

A

USS EFW >90th centile
AC >97th centile
Generic population based charts and customised growth charts (ethnicity, BMI, parity(

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4
Q

What are the risks assoc with foetal macrosomia?

A

Clinical and maternal anxiety
Labour dystocia
Shoulder dystocia
PPH

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5
Q

How accurate is USS in diagnosis of foetal macrosomia?

A

EFW is commonly overestimated in comparison to actual weight
Gestation more accurate <38 weeks
BMI of women will impact

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6
Q

What formula is used for estimation of EFW?

A

Hadlock

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7
Q

What is the management of macrosomia?

A

Exclude diabetes
Reassure
Conservative vs IOL (by 40 wks) vs C/S

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8
Q

What are the nice recommendations for macrosomia?

A

In absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic)

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9
Q

What is the recommendation if a baby is over 4.5 kg?

A

C/S

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10
Q

What is the definition of polyhydramnios?

A

Excess amniotic fluid

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11
Q

How is polyhydramnios diagnosed?

A

Amniotic fluid index > 25 cm

Deepest pool >8cm

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12
Q

What maternal factors can result in polyhydramnios?

A

Diabetes

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13
Q

What foetal factors can result in polyhydramnios?

A 
Anomaly; GI atresia, cardia, tumours
MCMA twin pregnancy 
Hydrops fetalis; rhesus isoimmunisation 
Viral infections; erythrovirus B19, toxoplasmosis, CMV
Idiopathic
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14
Q

What are the symptoms of polyhydramnios?

A

Abdominal discomfort
Preterm rupture of membranes
Preterm labour; pressure on uterus
Cord prolapse

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15
Q

What are the signs of polyhydramnios?

A

LFD; large for days
Malpresentation
Tense shiny abdomen
Inability to feel foetal parts

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16
Q

What investigations should be performed when a diagnosis of polyhydramnios is confirmed?

A

OGTT; exclude diabetes
Serology; toxoplasmosis, CVM, parvovirus
Antibody screen
USS; foetal surgery for lips and stomach (is there a good swallowing mechanism)

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17
Q

What is the management of polyhydramnios?

A

Patient information
Serial USS; growth, liquor volume, presentation
IOL by 40 weeks
Labour; risk of malpresentation, risk of cord prolapse, risk of preterm labour, risk of PPH, neonatal examination

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18
Q

What is the incidence of multiple pregnancies?

A

Spontaneous twins; 1:80
Spontaneous triplets; 1:10,000
Increased with assisted conception

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19
Q

What increase the risks of multiple pregnancy?

A 
Assisted conception; clomid, IVF
Race; african 
FMHx
Increased maternal age
Increased parity
Tall women > short women
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20
Q

What are the different types of twins?

A

Zygosity; monozygotic or dizygotic

Chorionicity; 1 or 2 placentas

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21
Q

What will splitting of the embryo at day 0-3 result in?

A

Dichorionic
Diamniotic
Monozygotic twins

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22
Q

What will splitting of the embryo at day 4-7 result in?

A

Monochorionic
Diamniotic
Monozygotic twins

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23
Q

What will splitting of the embryo at day 8-14 result in?

A

Monochorionic
Monoamniotic
Monozygotic twins

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24
Q

What will splitting of the embryo at day 15 result in?

A

Conjoined twins

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25
Q

How is chorionicity determined via USS?

A

Shape of membrane and thickness of membrane

Foetal sex

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26
Q

What is lambda sign?

A

Placental masses, appearance of membrane attachment and membrane thickness

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27
Q

Why is chorionicity important?

A

MCMA monozygous twins have a higher risk of pregnancy complications

28
Q

What are the signs of a multiple pregnancy?

A

Exaggerated pregnancy symptoms e.g. hyperemesis

29
Q

What are the signs of a multiple pregnancy?

A

High AFP
Large for dates uterus
Multiple foetal poles
USS confirmation at 12 weeks

30
Q

What are the foetal complications of a multiple pregnancy?

A 
Congenital anomalies
IUD (single or both) 
Preterm birth 
Growth restriction 
CP 
TTTS;  oly poly
31
Q

What are the maternal complications of a multiple pregnancy?

A 
HG 
Anaemia
PET 
Antepartum haemorrhage; abruption, placental praevia
Preterm labour
C/S
32
Q

What is the antenatal management of a multiple pregnancy?

A

Twin/ multiple pregnancy clinic
MC; every 2 weeks
DC; every 4 weeks
Maternal education; preterm labour, support, TAMBA

33
Q

What medications should be given to multiple pregnant women?

A

Fe supplementation
Low dose aspirin; PET
Folic acid

34
Q

What ultrasounds should be performed in antenatal management?

A

MC 2 weekly from 16/40
Anomaly USS 18-20 wks
DC 4 wkly

35
Q

What should be assessed on USS for twins?

A

Deep vertical pool
Bladder
Umbilical artery doppler (UAPI)
EFW

36
Q

For monochorionic twins; what are the complications?

A

Single foetal death
Selective growth restriction
TTTS
TAPS (twin anaemia polycythaemia sequence)
Absent EDV or reserved - issues with uterine artery

37
Q

How is TAPS assessed?

A

Occurs following fetoscopic laser ablation for TTTS

Middle cerebral artery peak systolic velocity

38
Q

What is TTTS?

A

Syndrome with artery vein anastomosis

Donor twin perfuses the recipient twin

39
Q

How is TTTS diagnosed?

A

One twin with oligohydraminos
One twin with polyhydramnios
Oy Poly

40
Q

Complications of TTTS?

A

Mortality >90% with no treatment

Neurological morbidity

41
Q

How is TTTS treated?

A

Before 26/40; fetoscopic laser ablation
>26/40; amnioreduction/septostomy
Deliver 36-36/40

42
Q

What is the risk with MCMA twins in birth?

A

Cord entanglement

Risk of foetal death

43
Q

What is the recommendation for MCMA twins birth?

A

C/section 32-34+0 weeks

44
Q

When should DCDA twins be delivered?

A

37-38 weeks

45
Q

When should MCDA twins be delivered?

A

36 + 0 weeks

GIVE STEROIDS

46
Q

What is the mode of delivery recommended for twins?

A

Triplets or MCMA; c/s

If one twin cephalic; vaginal

47
Q

What should be the maximum time elapsed between twin deliveries?

A

Less than 30 mins
Oxytocin drip given after twin 1 delivered
USS to confirm presentation

48
Q

How should the 3rd stage of delivery be managed in women with twins?

A

Actively

49
Q

What is gestational diabetes?

A

Carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy

50
Q

Complications of diabetes in pregnancy?

A

Congenital anomalies; related to higher hbA1c
Miscarriage
IUD
Worsening diabetic cx; retinopathy, nephropathy

51
Q

What maternal complications occur in diabetic mothers?

A 
PET
Polyhydramnios
Macrosomia
Shoulder dystocia 
Neonatal hypoglycaemia
52
Q

With what HbA1c should pregnancy be avoided?

A

Above 86 mmol/mol (10%)

53
Q

What medications that are commonly prescribed in diabetic women need to be stopped preconception?

A

ACEi

Statins

54
Q

Should folic acid be given to diabetic women pre-pregnancy?

A

YES

5mg 3 months pre conception and first 12 weeks of pregnancy

55
Q

RF for gestational diabetes?

A 
Previous GDM 
Obesity BMI 30 or more 
FMHx 1st degree relative 
Ethnic variation 
Previous big baby 
Polyhydramnios 
Glycosuria (+1 on 2 occastions or +2 on one occasion warrants OGTT)
56
Q

What is the pathophysiology of GDM?

A

Pregnancy is diabetogenic; hPL and cortisol result in a relative insulin resistance

57
Q

What are the consequences of GDM?

A

Overgrowth of insulin sensitive tissues = macrosomia
Hypoxaemic state in utero
Short term metabolic cx
Foetal metabolic reprogramming leading to increased long term risks of obesity, insulin resistance and diabetes

58
Q

Screening and diagnosis of GDM?

A

RF at booking
Previous GDM; BG monitoring or OGTT 1st trim
OGTT at 24-28 wks

59
Q

How is OGTT performed?

A

Venous fasting blood glucose
75g glucose solution
2hr venous glucose
MINIMAL activity between tests; do NOT send home

60
Q

What are the diagnostic values in the SIGN guidance?

A

Fasting >5.1 mmol/l

2 hour > 8.5 mmol/l

61
Q

What is the general approach in terms of education for mothers with GDM?

A

Role of diet, body weight and exercise
Risks; macrosomia, neonatal hypoglycaemia
Importance of glycaemic control
Possibility of transient morbidity in baby
Increased risk for baby of obesity and diabetes in later life

62
Q

What are the glycaemic targets in nGDM?

A

Minimum 4 times a day finger prick - pre meals and before bed
Fasting; 3.5-5.5 mmol/l
1hr post meal; <7.8

63
Q

Management of GDM?

A

Diet, wt control and exercise
Monitor for PET
Growth scans
Consider hypoglycemic agents; insulin or oral tablet

64
Q

Does injectable insulin cross the placenta?

A

No

65
Q

When should delivery be aimed for in women with pregestational diabetes?

A

38 wks onwards

Earlier if complications

66
Q

When should delivery be aimed for in women with GDM?

A

On insulin tx; 38-39 wks
Metformin; 39-40 wks
Diet alone 40-41 wks
If foetal macrosomia, IUGR, PET then delivery earlier

67
Q

When should BG be checked in the postnatal period from women who had GDM?

A

FBG 6-8 wks PN
If T2DM picture; OGTT 6 wks PN
Annual FBG and lifestyle changes

Repro and Sexual Health (77 decks)

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