Obs - LGA & Shoulder Dystocia Flashcards
39 weeks, previously normal, fundus large for date, referred from MCH. What are the possible reasons?
Polyhydramnios
GDM
Uterine fibroid
Macrosomia due to other reason such as congenital abnormality
Less likely: multiple pregnancy, date problem, gestational trophoblastic disease
What is your plan of management?
Review the history of early pregnancy scan and gynaecology history
• Abdominal exam to confirm fundal height, fetal presentation, rule out multiple
pregnancy, look for abnormal mass
• TAS for fetal growth parameters, liquor and uterine structure
• OGTT for GDM
30-year-old para 0 lady, OGTT 6.5/9.1 at 26 weeks, Family history of DM: mother and sister
Diagnosis and management?
Diagnosis is GDM
- Antepartum
Non-pharmacological: Refer DM class by midwife and dietitian for education and dietary advice, monitor CBG
If failed, pharmacological: subcutaneous insulin + weekly CTG
regular USG for growth parameter
Plan mode of delivery. IOL at 40w on insulin, 38w or C/S if macrosomia - Intrapartum
capillary blood glucose monitoring
If on insulin, continuous insulin infusion using slide scale pump - Postpartum
PPH
OGTT at 6-8 weeks postpartum.
Advise increased risk of GDM, DM, HT
USG scan report at 38 weeks showing that birth weight 3.5 kg, liquor normal, growth parameters all along normal except AC > +2SD this time
Dx is Large for gestational age.
Increased risk of shoulder dystocia.
IOL at 38 weeks with doctor standby during second stage for instrumental
the lady is put on IOL. Nurse noticed prolonged second phase and turtle sign. What will you do?
Call for help
Lie mother flat
Large mediolateral episiotomy
Attempt maneuvres, 30s each
McRoberts manoeuvre: hyperflex thigh against abdomen to tilt pelvis
Suprapubic pressure
Internal: rubin II, woodscrew, reversed woodscrew to turn the fetal shoulder from AP to oblique
Roll over mother
Give baby to neonatalogist
Check for PPH
