Large for dates

Question 1

Which standard measurement = large for date?

Answer 1

symphyseal-fundal height >2cm for gestational age.

Question 2

Diagnosis of foetal macrosomia (centiles).

Answer 2

USS EFW >90th centile, AC >97th centile

Question 3

What is the NICE recommendation re large for dates babies and management?

Answer 3

NICE: in the 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.

Question 4

What is polyhydramnios?

Answer 4

excess amniotic fluid

Question 5

What are some foetal causes of polyhydramnios?

Answer 5

anomaly
monochorionic twins
hydros fetalis (Rh immunisation)
viral infection (erythrovirus B19, toxoplasmosis, CMV)

Question 6

What is the main maternal cause fo polyhydramnios?

Answer 6

diabetes

Question 7

Symptoms for polyhydramnios.

Answer 7

abdominal discomfort
pre-labour rupture of membranes (PROM)
preterm labour
cord prolapse

Question 8

Pregnant lady with abdominal discomfort, tense shiny abdomen presents in suspected preterm labour. You are unable to feel foetal parts - diagnosis?

Answer 8

polyhydramnios

Question 9

Polyhydramnios investigations?

Answer 9

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

Question 10

diagnosis of polyhydramnios.

Answer 10

USS confirmation:
amniotic fluid index >25cm
deepest venous pool >8cm

Question 11

If a diabetic mother with polyhydramnios is at 40+3 weeks - what do you do?

Answer 11

induction of labour at 40 weeks

Question 12

WHO definition of GDM.

Answer 12

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

Question 13

congenital anomalies are related to what if mother has diabetes?

Answer 13

HbA1c at booking

Question 14

What recommendations are made pre-pregnancy to a woman with diabetes?

Answer 14

HbA1c: 48mmol/mol (6.5%)
avoid pregnancy if 86mmol/mol (10%)
stop ACE-i, statins
high dose folic acid 5mg (3m before conception-12w pregnancy)
LDA from 12w

Question 15

When do diabetic mothers get an additional foetal anomaly scam and when do they deliver by?

Answer 15

scan at 18-20 weeks

deliver at 38w (earlier if complications)

Question 16

When and what is the diagnostic test for GDM?

Answer 16

OGTT at 24-28 weeks.

venous FBS - given 75g glucose solution - measure 2hr venous glucose - minimal activity between tests

Question 17

What are SIGN diagnostic values for GDM from diagnostic test?

Answer 17

fasting >/= 5.1 mmol/l

2-hour >/= 8.5 mmol/l

Question 18

Describe glycemic targets during pregnancy.

Answer 18

minimum 4x /day (pre-meals and before bed)
fasting: 3.5-5.5 mmol/l
1-hr: <7.8 mmol/l

Question 19

Describe delivery timings for GDM when on:

i) insulin
ii) metformin
iii) diet alone

Answer 19

insulin: 38-39 weeks
metformin: 39-40 weeks
diet alone: 40-41 weeks

Question 20

What are the main risk factors for future development of T2DM in the post-natal period?

Answer 20

obesity
insulin use during pregnancy
fasting glucose levels from OGTT in pregnancy
IGT post-partum
ethnic group

Question 21

When determining chorionicity on USS, what is being looked for?

Answer 21

shape of membrane and its thickness

foetal sex

Question 22

Which twin type are at higher risk fo pregnancy complications?

Answer 22

monochorionic/monozygous twins

Question 23

If you saw lambda sign on USS of pregnant lady - what would you tell her?

Answer 23

dichorionic diamniotic twins

Question 24

If you saw T-sign on USS of pregnant lady - what would you tell her?

Answer 24

monochorionic diamniotic twins

Question 25

What are some signs of multiple pregnancies?

Answer 25

high AFP
large for dates uterus
multiple foetal poles

Question 26

Pregnant lady presents at 15 weeks with excessive sickness and you measure high AFP - diagnosis?

Answer 26

twins/multiple pregnancy

Question 27

How often do pregnant ladies with MC twins have clinic appointments?

Answer 27

every 2 weeks from 16/40

Question 28

How often do pregnant ladies with DC twins have clinic appointments?

Answer 28

every 4 weeks

Question 29

When do you deliver MCDA/DCDA babies?

Answer 29

DCDA twins at 37-38 weeks

MCDA twins after 36+0 (w/ steroids)

Question 30

When would you aim to deliver twins vaginally?

Answer 30

if twin one is cephalic

Question 31

What is the inter-twin delivery time goal?

Answer 31

<30 mins

Question 32

What is a monozygotic pregnancy?

Answer 32

splitting of a single fertilised egg

Question 33

What is a dizygotic pregnancy?

Answer 33

fertilisation of 2 ova by 2 spermatozoa

Question 34

With regards to monozygotic twins, their chorionicity depends on when the fertilised ovum splits. Describe the timeline of twin types & development.

Answer 34

Day 0-3 after fertilisation: DCDA
Day 4-7 after fertilisation: MCDA
Day 8-14 after fertilisation: MCMA
Day 15 onwards: conjoined twins

Question 35

In selective growth restriction, how do you calculate EFW discordance?

Answer 35

(larger EFW-smaller EFW) / larger EFW x100

Question 36

What is TTTS?

Answer 36

twin-to-twin transfusion syndrome

syndrome with artery-vein anastomoses; donor twin perfuses the recipient twin; rare after 26/40

Question 37

How do you diagnose TTTS?

Answer 37

oligohydramnios-polyhydramnios (oly-poly)

Question 38

What is the treatment for TTTS?

Answer 38

<26/40: fetoscopic laser ablation
>26/40: amnioreduction/ septostomy
34-36/40: deliver