Large for Dates Pregnancies Flashcards
how do you work out if a pregnancy is large for date?
symphyseal fundal height >2cm
what country has the highest twinning rate in the world?
nigeria (african countries have a higher twin rate)
causes of LFD pregnancies?
wrong dates foetal macrosomia polyhydramnios diabetes multiple pregnancy
when would you suspect LFD caused by low weight?
if mum has booked antenatal care late:
could be a concealed pregnancy
vulnerable woman
transfer of care from another district
define foetal macrosomia?
big baby
EFW >90th centile
risks for fetal macrosomia
anxiety
labour dystocia
shoulder dystocia
PPH
management of fetal macrosomia?
exclude diabetes
reassure
conservative vs IOL vs CS delivery
what does polyhydramnios look like on USS?
black (fluid is black)
what size pool of amniotic fluid indicates polyhydramnios?
> 8cm
define polyhydramnios?
excess amniotic fluid
amniotic fluid index > _cm indicates polyhydramnios
25
maternal causes of polyhydramnios
diabetes
foetal causes of polyhydramnios?
anomaly eg GI atresia, cardiac monochorionic twin pregnancy hydrops fetalis viral infection idiopathic
presentation of polyhydramnios?
abdo discomfort
prelabour rupture of membranes
preterm labour
cord prolapse
Ix of polyhydramnios
OGTT to exclude diabetes
serology to exclude virus
antibody
USS
signs of polyhydramnios?
LFD
malpresentation
tense shiny abdomen
inability to feel foetal parts
incidence of twins ratio?
1:80
risk factors for multiple pregnancy?
ART african race geography FH increased maternal age increased parity tall women
dizygous twins have what chorionicity and what amnioticity?
dichorionic
diamniotic
monzygous twins can have what chorionicity and what amnioticity?
can be mono/dichorionic or mono/diamniotic
if twinning occurs very early (3 days) after fertilisation its likely the twins will be _chorionic and _amniotic
di
if twinning occurs within days 4-8 after fertilisation its likely the twins will be _chorionic and _amniotic
monochorionic
diamniotic
how is chorionicity determined?
shape and thickness of membrane on USS
foetal sex
__chorionic and __zygous twins are more at risk of pregnancy complications
mono
mono
symptoms of multiple pregnancy
exaggerated pregnancy symptoms eg HG
signs of multiple pregnancy
high AFP
large for dates uterus
multiple foetal poles
when is multiple pregnancy confirmed on USS
12 weeks
foetal complications of multiple pregnancy?
congenital anomalies IUD preterm birth growth restriction cerebral palsy
maternal complications of multiple pregnancies?
HG anaemia preeclampsia entepartum haemorrhage preterm labour CS
how often is a pregnancy with monochorionic twins seen? from when?
every 2 weeks from 16 weeks
how often is a pregnancy with dichorionic twins seen?
every 4 weeks
antenatal Tx of mothers with multiple pregnancy?
iron supplementation
low dose aspirin
folic acid
USS scans
Tx of oligohydramnios-polyhydramnios
before 26 wks - fetoscopic laser ablation
after 26 wks - amnioreduction/septostomy
what does monochorionic monoamniotic twins mean in utero?
they share a sac and a placenta
when should you deliver MCMA twins?
32-34 weeks by CS
when would you deliver DCDA twins?
37-38 weeks
when would you deliver MCDA twins?
after 36 weeks WITH STEROIDS
how would you deliver triplets?
always CS
how would you deliver twins?
SVD if first twin is normal (cephalic not breech), CS if first is breech
what Ix should be done in labour?
epidural
USS and FSE
syntocinon after twin 1 delivery
USS to confirm presentation
what is the max time between twin deliveries?
30 mins
what birth complications are specific to pre-existing diabetes
congenital abnormalities
miscarriage
intrauterine death
what birth complications are common to pre-existing and gestational diabetes?
preeclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypoglycaemia
target HbA1C for prepregnancy in diabetic women?
6.5% (48mmol/mol)
pregnancy should be avoided at what HbA1C?
10% (86mmol/mol)
what should be done in pre-pregnancy counselling of diabetic women?
stop teratogenic meds eg ACEi
determine micro/macrovascular complications
high dose folic acid 5mg
advice
when is folic acid given in diabetic pregnant women?
3 months before conception to 12 weeks gestation
Tx of diabetes in pregnancy?
usual medication PLUS:
folic acid 5mg
low dose aspirin from 12 weeks
when should diabetic mum’s babies be delivered?
38 weeks
how often are growth scans done in diabetes and when?
every month from 28 weeks
risk factors for GDM?
previous GDM BMI >30 FH asian/black ethnicity previous big baby polyhydramnios glycosuria 1+ on >1 occasion
how does DM harm baby?
placental hormones become insulin resistant
overgrowth of insulin sensitive tissues and macrosomia
fetal metabolic reprogramming increases long term risk
Ix of GDM
assess risk factors
OGTT 24-28 weeks (do in first trimester too if previous GDM)
fasting glucose over __mmol/l indicates GDM
5.1
2hr glucse over __mmol/l indicates GDM
8.5
target fasting glucose levels in GDM?
3.5-5.5mmol/l
target post-meal glucose levels should be under __mmol/l in GDM?
<7.8mmol/l
when should post-meal glucose levels be taken?
1 hour
how often should BGLs be taken per day?
4 times
if a patient has GDM and is on metformin when should you deliver?
39-40 weeks
if a patient has GDM and is on insulin when should you deliver?
38 weeks
how should a baby be delivered in GDM?
maternal preference (tell them the risks)
if EFW is >__kg do a c section
4.5
