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3 Reproduction and Sexual Health > Large for Dates Pregnancies > Flashcards

Large for Dates Pregnancies Flashcards

1
Q

how do you work out if a pregnancy is large for date?

A

symphyseal fundal height >2cm

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2
Q

what country has the highest twinning rate in the world?

A

nigeria (african countries have a higher twin rate)

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3
Q

causes of LFD pregnancies?

A 
wrong dates
foetal macrosomia
polyhydramnios
diabetes
multiple pregnancy
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4
Q

when would you suspect LFD caused by low weight?

A

if mum has booked antenatal care late:
could be a concealed pregnancy
vulnerable woman
transfer of care from another district

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5
Q

define foetal macrosomia?

A

big baby

EFW >90th centile

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6
Q

risks for fetal macrosomia

A

anxiety
labour dystocia
shoulder dystocia
PPH

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7
Q

management of fetal macrosomia?

A

exclude diabetes
reassure
conservative vs IOL vs CS delivery

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8
Q

what does polyhydramnios look like on USS?

A

black (fluid is black)

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9
Q

what size pool of amniotic fluid indicates polyhydramnios?

A

> 8cm

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10
Q

define polyhydramnios?

A

excess amniotic fluid

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11
Q

amniotic fluid index > _cm indicates polyhydramnios

A

25

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12
Q

maternal causes of polyhydramnios

A

diabetes

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13
Q

foetal causes of polyhydramnios?

A 
anomaly eg GI atresia, cardiac
monochorionic twin pregnancy
hydrops fetalis
viral infection
idiopathic
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14
Q

presentation of polyhydramnios?

A

abdo discomfort
prelabour rupture of membranes
preterm labour
cord prolapse

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15
Q

Ix of polyhydramnios

A

OGTT to exclude diabetes
serology to exclude virus
antibody
USS

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16
Q

signs of polyhydramnios?

A

LFD
malpresentation
tense shiny abdomen
inability to feel foetal parts

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17
Q

incidence of twins ratio?

A

1:80

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18
Q

risk factors for multiple pregnancy?

A 
ART
african race
geography 
FH
increased maternal age
increased parity
tall women
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19
Q

dizygous twins have what chorionicity and what amnioticity?

A

dichorionic

diamniotic

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20
Q

monzygous twins can have what chorionicity and what amnioticity?

A

can be mono/dichorionic or mono/diamniotic

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21
Q

if twinning occurs very early (3 days) after fertilisation its likely the twins will be _chorionic and _amniotic

A

di

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22
Q

if twinning occurs within days 4-8 after fertilisation its likely the twins will be _chorionic and _amniotic

A

monochorionic

diamniotic

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23
Q

how is chorionicity determined?

A

shape and thickness of membrane on USS

foetal sex

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24
Q

__chorionic and __zygous twins are more at risk of pregnancy complications

A

mono

mono

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25
Q

symptoms of multiple pregnancy

A

exaggerated pregnancy symptoms eg HG

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26
Q

signs of multiple pregnancy

A

high AFP
large for dates uterus
multiple foetal poles

27
Q

when is multiple pregnancy confirmed on USS

A

12 weeks

28
Q

foetal complications of multiple pregnancy?

A 
congenital anomalies
IUD
preterm birth
growth restriction
cerebral palsy
29
Q

maternal complications of multiple pregnancies?

A 
HG
anaemia
preeclampsia
entepartum haemorrhage
preterm labour
CS
30
Q

how often is a pregnancy with monochorionic twins seen? from when?

A

every 2 weeks from 16 weeks

31
Q

how often is a pregnancy with dichorionic twins seen?

A

every 4 weeks

32
Q

antenatal Tx of mothers with multiple pregnancy?

A

iron supplementation
low dose aspirin
folic acid
USS scans

33
Q

Tx of oligohydramnios-polyhydramnios

A

before 26 wks - fetoscopic laser ablation

after 26 wks - amnioreduction/septostomy

34
Q

what does monochorionic monoamniotic twins mean in utero?

A

they share a sac and a placenta

35
Q

when should you deliver MCMA twins?

A

32-34 weeks by CS

36
Q

when would you deliver DCDA twins?

A

37-38 weeks

37
Q

when would you deliver MCDA twins?

A

after 36 weeks WITH STEROIDS

38
Q

how would you deliver triplets?

A

always CS

39
Q

how would you deliver twins?

A

SVD if first twin is normal (cephalic not breech), CS if first is breech

40
Q

what Ix should be done in labour?

A

epidural
USS and FSE
syntocinon after twin 1 delivery
USS to confirm presentation

41
Q

what is the max time between twin deliveries?

A

30 mins

42
Q

what birth complications are specific to pre-existing diabetes

A

congenital abnormalities
miscarriage
intrauterine death

43
Q

what birth complications are common to pre-existing and gestational diabetes?

A 
preeclampsia
polyhydramnios
macrosomia
shoulder dystocia
neonatal hypoglycaemia
44
Q

target HbA1C for prepregnancy in diabetic women?

A

6.5% (48mmol/mol)

45
Q

pregnancy should be avoided at what HbA1C?

A

10% (86mmol/mol)

46
Q

what should be done in pre-pregnancy counselling of diabetic women?

A

stop teratogenic meds eg ACEi
determine micro/macrovascular complications
high dose folic acid 5mg
advice

47
Q

when is folic acid given in diabetic pregnant women?

A

3 months before conception to 12 weeks gestation

48
Q

Tx of diabetes in pregnancy?

A

usual medication PLUS:
folic acid 5mg
low dose aspirin from 12 weeks

49
Q

when should diabetic mum’s babies be delivered?

A

38 weeks

50
Q

how often are growth scans done in diabetes and when?

A

every month from 28 weeks

51
Q

risk factors for GDM?

A 
previous GDM
BMI >30
FH
asian/black ethnicity
previous big baby
polyhydramnios
glycosuria 1+ on >1 occasion
52
Q

how does DM harm baby?

A

placental hormones become insulin resistant
overgrowth of insulin sensitive tissues and macrosomia
fetal metabolic reprogramming increases long term risk

53
Q

Ix of GDM

A

assess risk factors

OGTT 24-28 weeks (do in first trimester too if previous GDM)

54
Q

fasting glucose over __mmol/l indicates GDM

A

5.1

55
Q

2hr glucse over __mmol/l indicates GDM

A

8.5

56
Q

target fasting glucose levels in GDM?

A

3.5-5.5mmol/l

57
Q

target post-meal glucose levels should be under __mmol/l in GDM?

A

<7.8mmol/l

58
Q

when should post-meal glucose levels be taken?

A

1 hour

59
Q

how often should BGLs be taken per day?

A

4 times

60
Q

if a patient has GDM and is on metformin when should you deliver?

A

39-40 weeks

61
Q

if a patient has GDM and is on insulin when should you deliver?

A

38 weeks

62
Q

how should a baby be delivered in GDM?

A

maternal preference (tell them the risks)

63
Q

if EFW is >__kg do a c section

A

4.5

3 Reproduction and Sexual Health (51 decks)

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