Problems in Pregnancy: Large for Dates Flashcards
What are the main differentials for a large for dates pregnancy
wrong dates
multiple pregnancy
diabetes
polyhydramnios
define polyhydranios
excess amniotic fluid
What are the causes of polyhydramnios
Monochorionic twins fetal anomaly maternal diabetes Hydrops fetalis Idiopathic
What is hydrops fetalis
Hydrops fetalis is a condition in the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments
Name some causes of hydrops fetalis
Rh isoimmunisation, infestion (erythrovirus B19), alpha thalassaemia, iron deficiency anaemia
What are the symptoms/complications of polyhydramnios
Discomfort
Labour
Membrane rupture
cord prolapse
what is zygosity
Refers to the number of eggs fertilized to produce twins
eg monovular, or binovular
what is chorionicity
refers to the membrane pattern eg monochorionic diamniotic/monoamniotic or dichorionic
What type of twins are more at risk of pregnancy complication
monochrorionic/monozygous twins
What are the symptoms of multiple pregnancies
Exaggerated pregnancy symptoms eg sickness
High AFP
Large for dates
Feeling more than two fetal poles
why are twin pregnancies more complicated with higher perinatal mortality
Much higher perinatal mortality due to: Congenital anomalies Pre term labour Growth restriction Pre eclampsia Antepartum haemorrhage Twin to twin transfusion prematurity
how is a multiple pregnancy managed
More frequent antenatal visits Detailed anomaly scan at 18 weeks Regular scans from 28 weeks for growth Routine iron supplementation Warning to mother re risk and signs of pre term labour
how are multiple pregnancies delivered
Triplets or more – Caesarean section
Twins if twin one cephalic aim for vaginal delivery
Much greater risk of Caesarean section (approx 50%)
Epidural analgesia
what is gestational diabetes
carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
What are the consequences of gestational diabetes
Hyperinsulinaemia in placenta results in macrosomia
Hypoxaemia state in utero
Short term metabolic complicatins
Fetal metabolic reprogramming leading to increase long term risk of obesity, insulin resistance and diabetes
What are the risk factors for GDM
Family history of diabetes Previous big baby Previous unexplained still birth Recurrent glycosuria Maternal obesity Previous gestational diabetes
When are women screened for GDM
GTT based on risk factors OR
random blood glucose at booking and 28 weeks
When is a diagnosis of GDM made
GTT at 28 weeks
Fasting= more than 5.1 mmol/l
2 hour more than 8.5 mmol/l
What complications are associated with pre existing diabetes (note all related to poor control)
Congenital anomalies
Miscarriage
Intra uterine death
What complications are common to gdm and pre existing
Pre eclampsia Polyhydramnios Macrosomia Shoulder dystocia Neonatal hypoglycaemia
What is the mother with GDM more at risk of
developing type 2 diabetes post pregnancy
what are the target glucose levels in pregnancy
3.5-5.9 fasting
less than 7.8 1 hr post prandial
when are hypoglycaemic therapies considered
if diet and exercise fails to maintain target
macrosomia on ultrasound
what is tha advantage of oral agents over insulin in pregnancy
Potential advantages of oral hypoglycaemic
agents:
Avoidance of hypoglycaemia associated with insulin
Less weight gain
Less ‘education’ required to ensure safe / effective administration
how is obstetric care different in diabetes
Offer delivery from 38 weeks.
Consider C section in macrosomia (still performed often with no macrosomia)
Regular monitoring for PET.
2-4 weekly scans from 28 wks or diagnosis.
what is the risk of future type 2 diabetes development
risk up to 70 percent
what are the risk factors for developing diabetes after pregnancy with GDM
Obesity Use of insulin during pregnancy Fasting glucose levels from OGTT in pregnancy IGT post partum Ethnic group
what additional considerations have to be taken in pregnanct women with type 1 or 2 diabetes already established before pregnancy
fetal anomaly scan at 18 wks
eye checks for retinopathy
