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Reproductive and Sexual Health > Large for Gestational Age > Flashcards

Large for Gestational Age Flashcards

1
Q

What is characterised by ‘LGA’?

A

fundal height greater than 2cm of the normal for that gestation

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2
Q

How does fundal height tend to relate to gestational age?

A

match it e.g. 24 weeks gestation should have a fundal height of 24cm

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3
Q

What is foetal macrosomnia?

A

This is basically a ‘big baby’ and can be caused by many things.
Defined as an USS estimated foetal weight (EFW) as > 90th centile on population and personalised growth charts

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4
Q

What is a customised growth chart?

A

this take into account the mothers ethnicity, BMI and parity to allow for adjustment

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5
Q

What are the risks of delivering a macrosomic baby?

A

labour or shoulder dystocia (obstruted labour)

PPH

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6
Q

What should be excluded if a baby is macrosomic?

A

Diabetes

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7
Q

What is the management of a macrosomic baby?

A

Reassurance and think about induction of labour (early) or C-section

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8
Q

What is polyhydramnios?

A

Excess of amniotic fluid

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9
Q

How is amniotic fluid measured and what boundaries are considered polyhydramnios?

A

Amniotic fluid index (AFI) >25
Deepest pool >8cm

(along with a sujective impression)

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10
Q

What causes polyhydramnios?

A

Maternal - diabetes
Foetal - anomaly (GI atresia, cardiac etc), foetalis hydrops, monochorionic twin pregnancy, viral infection (erythrovirus B19, CMV and toxoplasmosis)

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11
Q

What is foetalis hydrops?

A

This is the abnormal collection of fluid in at least 2 places e.g. under skin, abdominal cavity, pleural effusion, pericardial effusion

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12
Q

What is monochorionic twin pregnancy?

A

monozygotic twins that share the same placenta

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13
Q

What can cause hydrops foetalis?

A

This can be caused by immune process (anti-RhD attacking RBC causing haemolysis in the foetal spleen and collection of excess fluid) or non-immune process (relating to failure of interstitial fluid to enter the venous system)

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14
Q

What are the symptoms of polyhydramnios?

A

Abdominal discomfort
premature rupture of membranes
cord prolapse
pre-term labour

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15
Q

What are the signs of polyhydramnios?

A

large for dates
tense shiny abdomen
inability to feel foetal parts
malpresentation

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16
Q

What investigations should be carried out for polyhyrdramnios causes?

A

OGTT - maternal diabetes
Serology - CMV, toxoplasmosis, erythrovirus B19
Antibody screen
USS - for foetal survey

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17
Q

What can increase risk of multiple pregnancy?

A 
Age (older)
Parity (more)
Height (taller)
Ethnicity (african)
Assisted conception
Family history
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18
Q

What are monozygotic twins?

A

When 2 foetuses are derived from the same egg (e.g. egg splits) - 30%

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19
Q

What are dizygotic twins?

A

When there are 2 eggs fertilised

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20
Q

What is chorionicity?

A

This is the number of placentas:
mono - one
di - 2 (always di-amniotic)

21
Q

If there is splitting of the morula (days 1-3) into monozygotic twins what will the amniotic sac and placenta be?

A

Diamniotic dichorionic

22
Q

If there is splitting on the blastocyst (days 4-7) into monozygotic twins what will the amniotic sac and placenta be?

A

Diamniotic monochorionic

23
Q

If there is splitting of the implanted blastocyst (days 8-14) into monozygotic twins what will the amniotic sac and placenta be?

A

Monoamniotic monochorionic

24
Q

If there is splitting of the blastocyst once the embryonic disc has formed (after day 15) what will happen?

A

Conjoined twins

25
Q

What will lambda sign on USS show?

A

Dichorionicity in a twin pregnancy - although absence cannot exclude two placentas present
Seen at around 11-14 week scan
(and diamniocity)

26
Q

What will a T sign show on USS?

A

Monochorionicity in a twin pregnancy (with diamniocity)

27
Q

Is monochorionic twin pregnancy worse or better?

A

at risk of more complications during pregnancy

28
Q

What are the symptoms of multiple pregnancy?

A

exagerrated symptoms of pregnancy e.g. hyperemesis gravidarum

29
Q

What are the signs of multiple pregnancy?

A

High AFP
Large for dates
Multiple foetal poles (thickened margin of the yolk sac that is the first sign of an embryo - seen on scan around 6-9weeks)

30
Q

What is the length of foetal pole when a heartbeat should be detected?

A

> 7mm

31
Q

What complications can affect a multiple pregnancy?

A

They are at a 6x higher risk of perinatal death:

  • congenital anomalies
  • growth restriction
  • IUD
  • preterm
  • cerebral palsy
  • twin to twin transfusion
32
Q

What can occur in the mother in terms of complications in multiple pregnancy?

A
  • anaemia
  • hyperemesis gravidarum
  • pre-eclampsia
  • antepartum haemorrhage (placental abruption/praevia)
  • pre-term labour/c-section
33
Q

Describe the antenatal management of a multiple pregnancy

A

Consultant led
If monochorionic then clinic appointments every 2 weeks (and USS every 2 weeks from 16 weeks onwards)
if dichorionic then clinic appointments every 4 weeks (with USS)

Anomaly scan at 18 weeks

34
Q

What medications can be given to support a multiple pregnancy?

A

Iron supplements
low dose aspirin
folate supplements

35
Q

What are monochorionic twins at risk of?

A

single foetal death - with a 15% risk of survivor passing too. need to mri survivor brain 4 weeks after IUD.

Selective growth restriction - disproportionate nutrition resulting in growth restriction of one

Twin anaemia-polycythaemis sequence

Twin-twin transfusion

absent/reversed EDV

36
Q

What is twin anaemia-polycythaemia sequence (TAPS)

A

There is unequal sharing of blood between the twins resulting in one having anaemia and the other having polycythaemia (type of twin-twin transfusion)

37
Q

What is twin-twin transfusion syndrome (TTTS)?

A

this is where there are normal blood vessel connections between the foetuses resulting in one becoming a ‘donor’ and the other becoming the ‘recipient’ - R has high BP and produces a lot of urine resulting in overfilling of the amniotic sac.

38
Q

How are monochorionic monoamniotic twins delivered and why?

A

C-section between 32-34 weeks due to the high risk of cord enlangement and foetal death

39
Q

What is gestational diabetes?

A

carbohydrate intolerance resulting in hyperglycaemia that starts with pregnancy

40
Q

What can uncontrolled pre-existing diabetes cause in pregnancy?

A

Intra-uterine death
anomalies (if HbA1C is high at first booking)
Miscarriage

41
Q

What are complications shared by pre-existing and gestational diabetes?

A 
Pre-clampsia
polyhydramnios
macrosomnia
shoulder dystocia
neonatal hypoglycaemia
42
Q

What is the guidelines for pre-pregnancy counselling in patients with pre-existing diabetes?

A

avoid pregnancy is >86mmol/mol (10%) - aim for 48mmol/mol
Stop ACEi and statins
calculate macro and microvascular risks
High dose folate 3 months prior to conception

43
Q

Why does gestational diabetes occur?

A

pregnancy hormones are diabetogenic and placental hormones cause relative insulin deficiency - this all results in overgrowth of insulin sensitive tissue and a hypoxaemic state in utero

44
Q

What are the risks to the child if gestational diabetes?

A

Obesity, diabetes (due to foetal metabolic reprogramming in utero)

45
Q

How do you screen for gestational diabetes?

A

Identify risk factors at booking (previous hx, FHx, BMI>30, ethnicity, previous large baby etc)
If previous then OGTT in 1st trimester and repeat in 24-28 weeks

46
Q

What are the diagnostic values for gestational diabetes?

A

fasting >5.1mmol/mol

2hr OGTT > 8.5mmol/mol

47
Q

What are the glycaemic targets for gestational diabetes?

A

fasting = 3.5-5.5

1 hr post meal = <7.8

48
Q

What medications can be given in gestational diabetes?

A 
Insulin (doesn't cross the placenta but risk of hypo)
Oral tablet (no risk of hypo or weight gain)
49
Q

Why do you check bloods after birth in gestational diabetes?

A

check 6 weeks post-natal to determine if long term T2DM will be present

Reproductive and Sexual Health (27 decks)

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