Large for Dates Flashcards
What delivery complication does a “Large for date” baby predispose the mother to?
Shoulder Dystocia
Define a Large for date Baby:
Any bay between 4000g-4500g+
What causes a “large for date baby”
- Gestational diabetes
2. Multiple pregnancies
How is the cause of “large for date” baby investigated?
- OGTT
Who’s is a good candidate to be screened for “large for date” babies? (9)
- Asian/afrocarribean
- BMI >30
- FH of DM
- Previous unexplained still birth
- Polyhydraminous/Macrosommic baby
- Previous GDM
- Previous macrocosmic >4.5Kg
- Women with PCOS
- Glycosuria in 2 occasions in the pregnancy
When do we screen for “large for date” babies?
26-28 weeks - Maximal placental function
Describe is OGTT?
Fasting bloods taken
75 g glucose load
Take blood again in 2 hours
What are the abnormal values of OGTT?
Fasting and glucose load?
Fasting >5.6 mmol
Load > 7.8 mmol
How do you mange “Large for Date babies”
If OGTT +ve - refer to maternal medicine
If OGTT -ve - treat as normal pregnancy
What would you do if the mother had a previous baby with severe shoulder dystocia and is carrying another one?
Offer CS for shoulder dystocia
Treat as normal if previous mild
How is a “large for date” baby managed in non-diabetic women?
- No further scans after 36 weeks
- IF BMI <30 the cervix is favourable and IOL is recommended at 41 weeks
- IF BMI >30, the cervix is unfavourable and elective cesarian or IOL needed
How is first stage of labour managed in “Large for date” babies?
- IV line + G+S
- Continous CTG
- Pain relief
- Regular cervical assessment
- Augmentation of labour if needed
How is second stage of labour managed in “Large for date” babies?
- Early transfer for CS if no descent
- Senior midwife
- Senior registration + consultant
What are the maternal complications of shoulder dystocia?
- PPH
2. Trauma
What are the foetal complications of shoulder dystocia?
- Brachial plexus injury
- Asphyxia
- Erbs palsy (C5,C6)
- Internal rotation and adduction of shoulders and pronation of elbows
