Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 Obstetrics and Gynaecology > Pregnancy - large for dates > Flashcards

Pregnancy - large for dates Flashcards

1
Q

Define what large for gestational age is

A
  • A baby is classed as large for dates if USS EFW (estimated fetal weight) is >90th centile or AC (abdominal circumference) >97th centile for that gestational age

LGA is indicated if the SFH is >2cm for that gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes for a baby to be large for their gestational age ?

A
  • Wrong dates
  • Fetal Macrosomia
  • Polydramnios
  • Diabetes
  • Multiple Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the reasons you might have the wrong dates for a pregnanacy causing you to percieve the pregnancy as large for gestational age ?

A
  • Concelled pregnancy
  • Vulnerable women
  • Transfer of care - booked in abroad
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define what the term fetal macrosomia means

A

This described a baby which is constitutinally large due to familial genetics (i.e. the family just have large babies)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How is fetal macrosomia diagnosed ?

A
  • Using ultrasound - USS EFW >90th centile or AC >97th centile
  • Match these measurements against generic population based & customised growth charts (taking into account ethnicity, BMI & parity for customised ones)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk accompanied with fetal macrosomia ?

A
  • Clinican & maternal anxiety
  • Labour dystocia = obstructed labour
  • Shoulder dystocia = specific cause of labour dystocia where the ant.shoulder of the infant cannot pass, it is more common with DM and fetal macrosomia
  • PPH - bigger baby bigger risk of bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of fetal macrosomia ?

A
  • Exclude gestational diabetes - do a OGTT
  • Reassure if DM excluded
  • Desicion then needs to be made between conservative, IOL & c-section. - NICE recommends in the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define what polyhydraminios is

A

This is excess amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List the possible causes of polyhydraminios

A

Maternal - Diabetes

Fetal:

  • Anomaly- GI atresia, cardiac, tumours
  • Monochorionic twin pregnancy
  • Hydrops fetalis – Rh isoimmunisation
  • Viral infection (erythrovirus B19, Toxoplasmosis, CMV)

Idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the signs and symptoms of polyhydraminios ?

A

Symptoms:

  • Abdominal discomfort
  • Pre-labour rupture of membranes
  • Preterm labour
  • Cord prolapse

Signs:

  • LFD - i.e. SFH
  • Malpresentation
  • Tense shiny abdomen
  • Inability to feel fetal parts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is a diagnosis of polyhydraminios confirmed ?

A

Ultrasound - based on the following measurements:

  • Amniotic fluid index (AFI) > 25
  • Deepest vertical pocket (DVP) > 8cm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When a diagnosis of polyhraminios is made what investigations should then be carried out ?

A
  • OGTT - to check for DM
  • Seriology - toxoplasmosis, CMV, Parovirus
  • Antibody screen e.g. for Rh status
  • USS - fetal survey assesing e.g. lips, stomach etc to look for abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of polyhydraminios ?

A
  • Serial USS- growth, Left ventricle (LV), presentation
  • IOL by 40 weeks
  • Regarding labour there is a risk of malpresentation, cord prolapse, pre-term labour &PPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define what is meant by the term multiple pregnancy ?

A

This is the presence of > 1 fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risks for having a multiple pregnancy ?

A
  • Assisted conception
  • Geography - low risk in Japan/china, high risk in Nigeria
  • Fam history of them
  • Increased age
  • Increased parity
  • Tall women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a multiple pregnancy classified by ?

A
  1. Zygosity
  2. Chorionicity
17
Q

What can the zigosity of a multiple pregnancy be described as ?

A

Either monozygotic or dizygotic

  • Monozygotic = they develop from one zygote
  • Dizygotic = they develop from 2 different fertilised eggs

Note - A zygote is the union of the sperm cell and the egg cell. Also known as a fertilized ovum

18
Q

What can the chroionicity of a multiple pregnancy be described as ?

A

Chorionicity = the number of placentae a pregnancy has i.e. 1 or 2 etc

  • Dizygous - babies always have separate placentas & separate amniotic sacs (DCDA)
  • Monozygous - may share or have their own separate placentas & may share or have their own amniotic sac ==> babies can be DCDA (dichorionic, diamniotic), MCDA, MCMA or conjoined
19
Q

What is ultrasound used to assess in multiple pregnancies and why is this important ?

A
  • The chorionicity & fetal sex
  • It is important to assess the chorionicity because Monochorionic / monozygous twins at higher risk of pregnancy complications
20
Q

What are the signs/symptoms of a multiple pregnancy ?

A

Symptoms:

  • Exaggerated pregnancy symptoms e.g. excessive sickness/ hyperemesis gravidarum

Signs:

  • High AFP (alpha fetoprotein)
  • Large for dates uterus (SFH)
  • Mutiple fetal poles
21
Q

When and what is used to confirm a diagnosis of multiple pregnancy?

A
  • USS at 12 weeks (determines the gestational age, chorionicity, & screens for DS)
22
Q

List the fetal complications which may occur in a multiple pregnancy ?

A
  • Higher perinatal mortality i.e. death of a fetus or neonate (6X higher than singleton)
  • Congenital anomalies eg acardiac twin
  • IUD ( single/both)
  • Pre term birth
  • Growth restriction- both /discordant
  • Cerebral Palsy - (twins 8X higher, triplets 47X higher)
  • Twin to twin transfusion- oligohydramnios & polyhydramnios (MC twins)
  • Twin Anaemia- Polycythaemia Sequence (TAPS) (MC twins)
  • Absent EDV (AEDV) or Reversed (REDV) - associated with perinatal mortality
23
Q

List the maternal complications which may occur in a multiple pregnancy

A
  • Hyperemesis Gravidarum
  • Anaemia
  • Pre eclampsia
  • APH - abruption, placenta praevia
  • Preterm Labour
  • Caesarean section
24
Q

List the standard antenatal management of multiple pregnancies

A
  • Twin/mulitple pregnancy clinic
  • Maternal education
  • Medications - Fe supplements, aspirin, folic acid
  • Anomaly US at 18-20 weeks.
  • MC clinic 2 weekly and US 2 weekly from 16/40 onwards
  • DC clinic 4 weekly and US 4 weekly from 16/40 onwards
25
Q

What should be done if a single fetal IUD occurs during a multiple pregnancy ?

A
  • MRI fetal brain 4 weeks post IUD of co-twin (so of the one alive)
  • MCA PSV to check for fetal anaemia
26
Q

If selective growth restriction is detected during a multiple pregnancy, what may be considered ?

A
  • If early onset with abnormal dopplers consider selective reduction
  • Selective reduction is the practice of reducing the number of fetuses in a multiple pregnancy, say quadruplets, to a twin or singleton pregnancy.
27
Q

What is Twin Anaemia- P0lycythaemia Sequence (TAPS)?

A
  • It is a form of twin-to-twin transfusion syndrome (TTTS)
  • Results in a donor and a recipient twin, the donor twin can develop anaemia whilst the recipient twin can develop polycythaemia
28
Q

What are the risk factors for developing Twin Anaemia- Polycythaemia Sequence (TAPS)?

A

Occurs randomly or after fetoscopic Laser ablation for TTTS

29
Q

What is twin to twin transfusion syndrome (TTTS)?

A
  • It is a syndrome where the placenta contains artery-vein anastomoses which result in a donor twin perfusing the recipient twin.
  • It is Rare to occur after 26/40
30
Q

What are the signs of TTTS?

A
  • Polyhydramnios (excess amniotic fluid) in the sac of one twin
  • Oligohydramnios (decreased to no amniotic fluid) in the sac of the other twin
  • Size differences (discordance) in the twins
31
Q

If left untreated what is the outcome of TTTS?

A
  • Mortality >90% with no treatment
  • Neurological morbidity 37% and high in surviving twin if IUD
32
Q

What is the treatment of TTTS?

A
  • Before 26/40 – Rx fetoscopic laser ablation
  • >26/40- amnioreduction /septostomy
  • Deliver 34-36/40
33
Q

When and how should the following multiple pregnancies be birthed ?

  • DCDA
  • MCDA
  • MCMA
  • triplets or more
  • Conjoined twins
A
  • DCDA - 37 to 38 weeks
  • MCDA - after 36+0 weeks with steroids
  • MCMA - c-section
  • Triplets or more - c-section
  • Conjoined twins - MDT & specliased centres

For DCDA and MCDA - if twin one cephalic aim for vaginal delivery

34
Q

Describe the management of labour of a multiple pregnancy

A

Labour- High Risk:

  • Consultant Led Unit
  • Epidural analgesia
  • Fetal monitoring: USS & FSE (fetal scalp electrode)
  • Syntocinon after twin 1
  • USS to confirm presentation
  • Intertwin delivery time <30min
  • Risk of PPH- active 3rd stage

Y4 Obstetrics and Gynaecology (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions