Large for Dates pregnancy Flashcards

1
Q

Define

A

Term to identify macrosomic babies (≥4kg or ≥4.5kg – the definition varies) -> 10% of pregnancies

· Prenatally, 3 tools used to diagnose large for age

o 1st -> Symphysis-fundal height (SFH) à >90th/95th centile for gestational age à foetal biometry…

o 2nd -> Abdominal Circumference (AC) à >90th/95th centile for gestational age

o 2nd -> Estimated foetal weight (EFW) à >90th/95th centile for gestational age

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2
Q

Risk factors

A
  • High BMI
  • Foetal macrosomia (>4kg in a term infant)
  • Gestational or DM
  • Syndromes: Beckwith-Wiedemann, Simpson-Golabi-Behemel, Soto’s syndrome
  • Molar pregnancy
  • Polyhydramnios
  • Multiparity
  • Advanced maternal age
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3
Q

Signs and symptoms

A

On inspection -> excessive distension for gestational age

Abdomen -> increased SFH (symphysis fundal height), increased abdominal circumference

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4
Q

Investigation

A

OGTT – for gestational diabetes

Bloods – serum βHCG

USS – liquor volume, biometry

Genetic testing

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5
Q

Management

A

Detected at 18-21 weeks à repeat scan

Detected at 24-36 weeks à if acceleration of growth, arrange USS for foetal biometry

  • If follows same path (no drop/rise growth), then reassure this is normal, arrange another routine scan
  • Offer OGTT (gestational diabetes)

Detected at 36-40 weeks à if SFH is >90th centile on routine measurements à USS for foetal biometry

  • If EFW and AC on USS are >95th centile, return to routine care
  • Perform OGTT (gestational diabetes)
  • Care in labour + postnatally as per gestational diabetes dx at earlier gestation

Need to plan delivery and discuss risk of shoulder dystocia, nerve injuries, prolonged labour à offer CS

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6
Q

Complications

A
  • Shoulder dystocia
  • Hypoglycaemia in GDM
  • Respiratory distress syndrome – combination of GDM, need to deliver earlier
  • Intrauterine deformations – metatarsus adductus (foot bends inwards), hip subluxation
  • Increased mortality
  • Perineal tear
  • Prognosis -> early planning/care -> no difference in outcomes for LGA compared to normal
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