Large for dates Flashcards
Which standard measurement = large for date?
symphyseal-fundal height >2cm for gestational age.
Diagnosis of foetal macrosomia (centiles).
USS EFW >90th centile, AC >97th centile
What is the NICE recommendation re large for dates babies and management?
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.
What is polyhydramnios?
excess amniotic fluid
What are some foetal causes of polyhydramnios?
anomaly
monochorionic twins
hydros fetalis (Rh immunisation)
viral infection (erythrovirus B19, toxoplasmosis, CMV)
What is the main maternal cause fo polyhydramnios?
diabetes
Symptoms for polyhydramnios.
abdominal discomfort
pre-labour rupture of membranes (PROM)
preterm labour
cord prolapse
Pregnant lady with abdominal discomfort, tense shiny abdomen presents in suspected preterm labour. You are unable to feel foetal parts - diagnosis?
polyhydramnios
Polyhydramnios investigations?
OGTT
serology - toxoplasmosis, CMV, parvovirus.
antibody screen
USS - foetal survey; lips, stomach
diagnosis of polyhydramnios.
USS confirmation:
amniotic fluid index >25cm
deepest venous pool >8cm
If a diabetic mother with polyhydramnios is at 40+3 weeks - what do you do?
induction of labour at 40 weeks
WHO definition of GDM.
carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
congenital anomalies are related to what if mother has diabetes?
HbA1c at booking
What recommendations are made pre-pregnancy to a woman with diabetes?
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
When do diabetic mothers get an additional foetal anomaly scam and when do they deliver by?
scan at 18-20 weeks
deliver at 38w (earlier if complications)
When and what is the diagnostic test for GDM?
OGTT at 24-28 weeks.
venous FBS - given 75g glucose solution - measure 2hr venous glucose - minimal activity between tests
What are SIGN diagnostic values for GDM from diagnostic test?
fasting >/= 5.1 mmol/l
2-hour >/= 8.5 mmol/l
Describe glycemic targets during pregnancy.
minimum 4x /day (pre-meals and before bed)
fasting: 3.5-5.5 mmol/l
1-hr: <7.8 mmol/l
Describe delivery timings for GDM when on:
i) insulin
ii) metformin
iii) diet alone
insulin: 38-39 weeks
metformin: 39-40 weeks
diet alone: 40-41 weeks
What are the main risk factors for future development of T2DM in the post-natal period?
obesity insulin use during pregnancy fasting glucose levels from OGTT in pregnancy IGT post-partum ethnic group
When determining chorionicity on USS, what is being looked for?
shape of membrane and its thickness
foetal sex
Which twin type are at higher risk fo pregnancy complications?
monochorionic/monozygous twins
If you saw lambda sign on USS of pregnant lady - what would you tell her?
dichorionic diamniotic twins
If you saw T-sign on USS of pregnant lady - what would you tell her?
monochorionic diamniotic twins
