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1. Reproduction > Large for Dates > Flashcards

Large for Dates Flashcards

1
Q

What defines a large for date baby?

A

symphyseal-fundal height >2cm for gestational age

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2
Q

What can cause a large for date baby?

A

fetal macrosomia
polyhydraminos
diabetes
multiple pregnancy

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3
Q

How is fetal macrosomia diagnosed?

A

on ultrasound

  • estimated fetal weight >90th centile
  • estimated abdominal circumference >97th centile
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4
Q

What are the risks of fetal macrosomia?

A

clinician and maternal anxiety
labour dystocia - difficult birth
shoulder dystocia - more common in diabetics - anterior shoulder gets caught above the mothers pubic bone
post partum haemorrhage

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5
Q

How do you manage fetal macrosomia?

A

exclude diabetes
reassure
c/section if baby >4.5kg

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6
Q

What is polyhydraminos?

A

excess amniotic fluid

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7
Q

How is polyhydraminos defined?

A

amniotic fluid index >25mm

deepest pool >8cm

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8
Q

What causes polyhydraminos?

A 
maternal diabetes - most common
idiopathic - 2nd most common
fetal anomaly - GI atresia, cardiac, tumours
monochorionic twin pregnancy
hydrops fetalis
viral infection
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9
Q

How does polyhydraminos present?

A

abdo discomfort
pre labour rupture of the membranes
preterm labour
cord prolapse

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10
Q

What are the signs of polyhydraminos?

A

large for date
malpresentation
acute shiny abdomen
inability to feel foetal parts

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11
Q

How is polyhydraminos diagnosed?

A

USS for AFI and DP

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12
Q

What investigations should be done for polyhydraminos?

A

OGTT - to exclude diabetes
serology - toxoplasmosis, CMV, parvovirus
antibody screen

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13
Q

How is polyhydraminos managed?

A

induce labour by 40 weeks

serial ultrasounds

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14
Q

What’re the risks of polyhydraminos?

A

malpresentation
cord prolapse
preterm labour (before 37 weeks)
PPH

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15
Q

What are the spontaneous risks of twins and triplets?

A

twins = 1 in 80

triplets 1 in 10,000

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16
Q

What increases your chances of having multiple pregnancies?

A 
assisted conception
race - african more common
family history
increased maternal age
increased parity
tall women >short women
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17
Q

What is more common - dizygotic or monozygotic?

A

dizygotic - 70%

18
Q

What are dizygotic twins?

A

fertilisation of two ova by two sperm

19
Q

What are monozygotic twins?

A

splitting of a single fertilised egg

20
Q

What are the two types of chorionicity?

A

dizygotic chorionic - 1 placenta (dichorionic diamniotic DCDA)
monozygotic chorionic - 2 placentas - can be MCMA, MCDA o

21
Q

What do DCDA twins come from?

A

morula

day 0-3 after implantation

22
Q

What do MCMA twins come from?

A

implanted blastocyst

day 8-14 after implantation

23
Q

What do MCDA twins come from?

A

blastocyst

day 4-7 after implantation

24
Q

How is chorionicity determined?

A

ultrasound

25
Q

What do dizygotic chorionic look like on USS?

A

lambda sign

26
Q

What do monozygotic chorionic look like on USS?

A

T sign

27
Q

What type of twins are at highest risk of pregnancy complications?

A

MCMA and MCDA

28
Q

What are the symptoms of multiple pregnancy?

A

exaggerated pregnancy symptoms - ie sickness

29
Q

What are the signs of multiple pregnancy?

A

high AFP
large for dates uterus
multiple foetal poles

30
Q

When are multiple pregnancies confirmed on USS?

A

12 weeks

31
Q

What are the foetal complications that may occur due to multiple pregnancy?

A

congenital abnormalities eg acardiac twin
intrauterine death
growth restriction - both or disconcordant
cerebral palsy - twinsx8 higher, tripletsx4 higher
twin-twin transfusion - oligohrydroaminos+polyhydraminos

32
Q

What are the maternal complications that may occur due to multiple pregnancies?

A 
hyperemesis gravidarum
anaemia
pre eclampsia
antepartum haemorrhage
preterm labour
cesarean section
33
Q

How does the antenatal management of monochorionic twins differ?

A

clinic appointments every 2 weeks

ultrasounds 2 weekly from 16/40

34
Q

How does the antenatal management of dichorionic twins differ?

A

clinic appointments every 4 weeks

ultrasounds every 4 weeks

35
Q

What are monochorionic twin complications?

A 
single fetal death
selective growth restriction
twin to twin transfusion syndrome (TTTS)
twin anaemia - polycythermia sequence (TAPS)
absend EDV or reversed EDV
36
Q

What is twin to twin transfusion syndrome (TTTS)?

A

syndrome with artery-vein astamoses

donor twin perfuses the recipient twin

37
Q

When should DCDA twins be delivered?

A

37-38 weeks

38
Q

When should MCDA twins be delivered?

A

after 36+0 weeks with STEROIDS

39
Q

How should MCMA, triplets etc be delivered?

A

c/section

40
Q

What time should be aimed for between twins birth?

A

<30mins

syntocinon after twin 1

1. Reproduction (50 decks)

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