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Repro > Large For Dates (Polyhydramnios, Macrosomia, Multiple Pregnancy, Diabetes) > Flashcards

Large For Dates (Polyhydramnios, Macrosomia, Multiple Pregnancy, Diabetes) Flashcards

1
Q

Definition of large for dates

A

Symphyseal-fundal hieght >2cm for gestational age or in 90th centile or above

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2
Q

List 6 causes of large for dates?

A 
Wrong dates, 
Fetal macrosomia, 
Polyhydramnios, 
Diabetes, 
Multiple pregnancy, 
Obesity
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3
Q

Definition and diagnosis of fetal macrosomia?

A

Big baby - diagnosis when USS EFW >90th centile, AC >97th centile

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4
Q

Risks of fetal macrosomia? (3)

A

Labour dystocia,
Shoulder dystocia,
PPH

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5
Q

USS EFW is commonly over/under estimated in comparison to actual weight?

A

Commonly overestimated

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6
Q

Management of fetal macrosomia?

A

Exclude diabetes,
Conservative vs IOL vs C/S delivery:
Conservative if baby fine, IOL if gets to 40weeks and C/S if EFW >/ = 5kg

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7
Q

Definition and diagnosis of polyhydramnios?

A

Excess amniotic fluid - if amniotic fluid index > 25cm or if deepest pool >8cm

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8
Q

What is amniotic fluid index?

A

Sum of deepest pool of amniotic fluid in all 4 quadrants

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9
Q

List maternal cause of polyhydramnios?

A

Diabetes

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10
Q

List fetal causes of polyhydramnios? (4)

A

Anomaly e.g. GI atresia, cardiac, tumours,
Monochorionic twin pregnancy,
Hydrops fetalis - Rh isoimmunisation,
Viral infection e.g. erythrovirus B19, toxoplasmosis, CMV

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11
Q

Symptoms of polyhydramnios? (4)

A

Abdo discomfort,
Pre-labour rupture of membranes,
Preterm labour,
Cord prolapse

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12
Q

Signs of polyhydramnios? (4)

A

LFD,
Malpresentation cos baby can swim around,
Tense shiny abdo,
Inability to feel fetal parts

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13
Q

Investigations for polyhydramnios? (4)

A

OGTT,
Serology - toxoplasmosis, CMV, parvovirus,
Antibody screen,
USS - fetal survery - lips, stomach (if stomach bubble then baby can swallow fluid)

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14
Q

Management of polyhydramnios?

A

Serial USS for growth, volume assesment, presentation,
IOL by 40weeks,
Labour risks consider - malpresentation, cord prolapse, preterm labour, PPH

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15
Q

What is hydrops fetalis?

A

Accumulation of fluid in >2 body cavities of baby

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16
Q

Incidence of multiple pregnancies - twins/triplets?

A

Twins 1:80,

Triplets 1:10,000

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17
Q

What increases risks of multiple pregnancy? (6)

A 
Assisted conception, 
African race (Geographically more in Africa, then europe, then Asia), 
FH, 
Increased maternal age, 
Increased parity, 
Tall women > short women
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18
Q

30% of multiple pregnancies are monozygotic/dizygotic and 70% of multiple pregnancies are monozygotic/dizygotic?

A

30% - monozygotic,

70% - dizygotic

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19
Q

In terms of chorionicity, dizygous pregnancies are always ?

A

Dichorionic diamniotic

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20
Q

In terms of chorionicity, monozygous twins are either? (4)

A

Monochorionic monoamnitoic, monochorionic diamniotic, dichorionc diamniotic or conjoined

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21
Q

If morula undergoes cleavage in day 1-3, you get what type of chorionicity?

A

Dichorionic diamniotic (DCDA)

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22
Q

If blastocyst undergoes cleavage in day 4-8, you get what type of chorionicity?

A

Monochorionic diamniotic (MCDA)

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23
Q

If implanted blastocyst undergoes cleavage in day 8-13, you get what type of chorionicity?

A

Monochorionc monoamniotic (MCMA)

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24
Q

If formed embryonic disc undergoes cleavage in day 13-15, you get what type of chorionicity?

A

Conjoined twins

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25
Q

How is chorionicity determined?

A

USS to look at membrane for lambda sign or T sign and for fetal sex (will be DCDA if diff sexes)

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26
Q

What is lambda sign and what is T sign?

A

Lammda - AKA twin peak sign, is measured on USS at 11-13 weeks and indicated DCDA twins,
T-sign - monochorionic diamniotic

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27
Q

Which type of chorionicity has highest risk of pregnancy complications?

A

Monochorionic twins

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28
Q

Signs & symptoms of multiple pregnancy? (4) When confirmed on USS?

A 
Excessive sickness due to excessive bHCG, 
High AFP, (alpha fetal protein) 
Large for dates uterus, 
Multiple fetal poles, 
Confirmed at 12 weeks
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29
Q

Perinatal mortality is _ times more likely with multiple pregnancy than with singleton pregnancy?

A

6 times!!

30
Q

List 6 fetal complications of multiple pregnancy?

A

Congenital abnormalities,
IUD,
Pre-term birth,
Growth restriction,
Cerebral palsy ( x8 higher for twins, x47 for triplets),
Twin to twin transfusion - oligohydramnios & polyhydramnios

31
Q

List 6 maternal complications of multiple pregnancy?

A 
Hyperemesis gravidarum, 
Anaemia, 
Pre-eclampsia, 
Antepartum haemorrhage (e.g. abruption, placenta praevia), 
Preterm labour, 
C-section
32
Q

Antenatal medical management for multiple pregnancy? (3)

A

Iron supplements,
Low dose aspirin,
Folic acid to reduce anaemia risk

33
Q

USS antenatal management for MC and DC twins?

A

MC: 2 weekly until birth from 16/40 and anomaly at 18-20wks,
DC: 4 weekly from anomaly until birth

34
Q

USS MC scans need to assess? (4)

A

Deep vertical pool,
Bladders,
umbilical artery doppler,
EFW

35
Q

List 5 complications for monochorionic twins?

A 
Single fetal death, 
Selective growth restriction, 
Twin-to-Twin transfusion syndrome, 
Twin anaemia-polycythaemia sequence, 
Abnormal dopplers - absent edf or reversed edf
36
Q

If one fetus dies in monochorionic twins, other baby needs what every 4 weeks to assess for IUD and neurologically abnormality risks?

A

MRI fetal brain and MCA doppler

37
Q

Twin-to-twin transfusion syndrome definition and diagnosis?

A

Definition: Artery-vein anastomoses so donor twin perfuses the recipient twin,
Diagnosis: oligohydramnios-polyhydramnios

38
Q

Complications of twin-to-twin transfusion syndrome? (2)

A

Mortality >90% w/o treatment,

Neurologicaly morbidity high for surviving twin

39
Q

Twin-to-twin transfusion syndrome is rare after 26/40. What is treatment before 26/40 and treatment after 26/40 and for delivery?

A

Before 26/40 - fetoscopic laser ablation,
After 26/40 - amnioreduction/septostomy,
Deliver 34-36/40

40
Q

Complex multiple births occur in?

A

MCMA (cord entangelemnt so c/section at 32-34 weeks) or conjoined twins

41
Q

Delivery times for DCDA twins and MCDA twins respectively?

A

DCDA - 37-38 weeks,

MDA - 36 weeks

42
Q

Mode of delivery for triplets & MCMA?

A

C/section

43
Q

Delivery of twins - what is given after twin 1 and what is intertwin delivery time aim?

A

Syntocinon after twin 1, aim to delivery twin 2 within 3o mins

44
Q

Definition of gestational diabetes and when usually diagnosed?

A

Carb intolerance resulting in hyperglycaemia with onset or first recognition during pregnancy that resolves by end of pregnancy,
usually diagnosed in 3rd trimester

45
Q

Effect of pregnancy on diabetes? (7)

A 
Increases insulin requirements, 
N&V can precipitate DKA, 
Ketosis more common, 
Diabetic retinopathy worsens especially after rapid control of diabetes, 
Diabetic nephropathy can worsen, 
More hypos, more hypers, 
Pre-eclampsia
46
Q

Complications of diabetes on baby? (7)

A 
Congenital anomalies, 
Miscarriage, 
IUD, 
Polyhydramnios, 
Macrosomia, 
Shoulder dystocia, 
Neonatal hypoglycaemia
47
Q

Parent with gene mutation for MODY they have __ chance of passing onto child

A

50%

48
Q

MODY type HFN1alpha - prevalence, presentation age and treatment?

A

70% of MODY cases,
Presents teenage/early 20s,
Treatment sulphonylureas

49
Q

MODY type HFN4alpha - prevalence, presentation age and treatment?

A

Rare,
Hypoglycaemia soon after birth,
Treatment sulphonylureas -> insulin

50
Q

MODY type HFN1beta - presentation, presentation age and treatment?

A

Renal cysts, uterine abnormalities and gout,
Renal cysts may be seen in utero but diabetes develops later,
Treatment insulin & lifestyle

51
Q

MODY type glucokinase - presentation and treatment?

A

Presentation: usually picked up through routine testing e.g. in pregnancy,
Treatment: nothing

52
Q

HbA1C aim in pregnancy?

HbA1C level at which pregnancy should be avoided?

A

48mmol/mol,

Avoid pregnancy if above 86 mmol/mol

53
Q

What meds for diabetic women in pregnancy?

A

5mg (high dose) folic acid 3 months prior and 12 weeks pregnancy,
Low dose aspirin from 12 weeks until delivery,
Review diabetic meds

54
Q

USS how often for diabetic women in pregnancy?

A

20, 28, 32 and 36 weeks

55
Q

Delivery aim for women with Type 1& 2 Diabetes?

A

38+6/40 weeks

56
Q

Delivery aim for GDM - insulin treatment, diet controlled and metformin controlled GDM?

A

Insulin treatment - 38-39 wks,
Diet controlled - 40/41 wks,
Metformin - 39/40 wks

57
Q

GDM occurs in approx 2-18% of pregnancies in UK. WHy does GDM occur?

A

State of insulin resistance due to human placental lactogen and cortisol

58
Q

What is risk of developing T2 DM within 5 years if diagnosed with GDM during pregnancy?

A

50%

59
Q

List 6 factors for GDM?

A 
Previous GDM, 
Obesity BMI 30, 
FH, 
Ethnic variation, asia, africa, caribbean, 
Polyhydramnios, 
Big baby
60
Q

Screening of GDM?

A

Risk factors at booking,
OGTT 24-28wks,
If Previous GDM - BG monitoring, OGTT 1st trimester and repeat at 24-28 wks

61
Q

OGTT done how?

A

Fasted for 8 hours -> venous fasting blood glucose -> 75g glucose solution -> 2hr venous glucose after minimal activity

62
Q

Diagnostic values for OGTT?

A

Fasting > = 5.1mmol/l,

2 hour > = 7.5mmol/l

63
Q

GDM patients should check BG minimum 4 times a day. What are fasting, 1hr and 2hr glycaemic targets for GDM?

A

Fasting: 3.5-5.5 mmol/l,

1hr: <7.8 mmol/l,
2hr: <6.4 mmol/l

64
Q

GDM can be managed with diet, weight control and exercise. However when should hypolgycaemia agents (insulin/metformin) be considered? (2)

A

When diet & exercise fail,

When macrosomia on USS

65
Q

Insulin treatment crosses the placenta. T/F?

A

False - does not cross

66
Q

If EFW > _kg, offer c/section to women with diabetes

A

EFW > 4.5kg

67
Q

RIsk of shoulder dystocia in diabetic pregnancy?

A

10%

68
Q

BG of mother should be maintained between 4-7mmol/litre during delivery. Baby should be fed within _mins after delivery?

A

30mins

69
Q

Women with GDM get FBS how many weeks post natally?

A

6-8wks and yearly HbA1c

70
Q

Gestational diabetes management

A

Antenatal clinic within 1 week,
Dietician,
BG monitoring,
If fasting BG <7: diet & exercise, metformin if targets not reached in 1-2 weeks, insulin if metformin not enough, glibenclamide if still not enough.
If fasting BG >7: immediate treatment with insulin +/- metformin, consider glibenclamide if not enough/effective

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