Problems in Pregnancy: Large for Dates

Question 1

What are the main differentials for a large for dates pregnancy

Answer 1

wrong dates
multiple pregnancy
diabetes
polyhydramnios

Question 2

define polyhydranios

Answer 2

excess amniotic fluid

Question 3

What are the causes of polyhydramnios

Answer 3

Monochorionic twins
fetal anomaly
maternal diabetes
Hydrops fetalis
Idiopathic

Question 4

What is hydrops fetalis

Answer 4

Hydrops fetalis is a condition in the fetus characterized by an accumulation of fluid, or edema, in at least two fetal compartments

Question 5

Name some causes of hydrops fetalis

Answer 5

Rh isoimmunisation, infestion (erythrovirus B19), alpha thalassaemia, iron deficiency anaemia

Question 6

What are the symptoms/complications of polyhydramnios

Answer 6

Discomfort
Labour
Membrane rupture
cord prolapse

Question 7

what is zygosity

Answer 7

Refers to the number of eggs fertilized to produce twins

eg monovular, or binovular

Question 8

what is chorionicity

Answer 8

refers to the membrane pattern eg monochorionic diamniotic/monoamniotic or dichorionic

Question 9

What type of twins are more at risk of pregnancy complication

Answer 9

monochrorionic/monozygous twins

Question 10

What are the symptoms of multiple pregnancies

Answer 10

Exaggerated pregnancy symptoms eg sickness
High AFP
Large for dates
Feeling more than two fetal poles

Question 11

why are twin pregnancies more complicated with higher perinatal mortality

Answer 11

Much higher perinatal mortality due to:
Congenital anomalies
Pre term labour
Growth restriction
Pre eclampsia
Antepartum haemorrhage
Twin to twin transfusion
prematurity

Question 12

how is a multiple pregnancy managed

Answer 12

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

Question 13

how are multiple pregnancies delivered

Answer 13

Triplets or more – Caesarean section

Twins if twin one cephalic aim for vaginal delivery
Much greater risk of Caesarean section (approx 50%)
Epidural analgesia

Question 14

what is gestational diabetes

Answer 14

carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

Question 15

What are the consequences of gestational diabetes

Answer 15

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

Question 16

What are the risk factors for GDM

Answer 16

Family history of diabetes
Previous big baby
Previous unexplained still birth
Recurrent glycosuria
Maternal obesity
Previous gestational diabetes

Question 17

When are women screened for GDM

Answer 17

GTT based on risk factors OR

random blood glucose at booking and 28 weeks

Question 18

When is a diagnosis of GDM made

Answer 18

GTT at 28 weeks
Fasting= more than 5.1 mmol/l
2 hour more than 8.5 mmol/l

Question 19

What complications are associated with pre existing diabetes (note all related to poor control)

Answer 19

Congenital anomalies
Miscarriage
Intra uterine death

Question 20

What complications are common to gdm and pre existing

Answer 20

Pre eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia

Question 21

What is the mother with GDM more at risk of

Answer 21

developing type 2 diabetes post pregnancy

Question 22

what are the target glucose levels in pregnancy

Answer 22

3.5-5.9 fasting

less than 7.8 1 hr post prandial

Question 23

when are hypoglycaemic therapies considered

Answer 23

if diet and exercise fails to maintain target

macrosomia on ultrasound

Question 24

what is tha advantage of oral agents over insulin in pregnancy

Answer 24

Potential advantages of oral hypoglycaemic
agents:
Avoidance of hypoglycaemia associated with insulin
Less weight gain
Less ‘education’ required to ensure safe / effective administration

Question 25

how is obstetric care different in diabetes

Answer 25

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.

Question 26

what is the risk of future type 2 diabetes development

Answer 26

risk up to 70 percent

Question 27

what are the risk factors for developing diabetes after pregnancy with GDM

Answer 27

Obesity
Use of insulin during pregnancy
Fasting glucose levels from OGTT in pregnancy
IGT post partum
Ethnic group

Question 28

what additional considerations have to be taken in pregnanct women with type 1 or 2 diabetes already established before pregnancy

Answer 28

fetal anomaly scan at 18 wks

eye checks for retinopathy