Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Reproduction > Problems in Pregnancy: Large for Dates > Flashcards

Problems in Pregnancy: Large for Dates Flashcards

1
Q

what is the definition of a large for date baby?

A

symphyseal-fundal height >2cm for gestational age

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

what is the possible cause of a large for date baby?

A 
wrong dates 
foetal macrosomia 
polydramnios 
diabetes 
multiple pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is foetal macrosomnia diagnosed?

A

USS EFW >90th centile, AC >97th centile

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

what are the risks of foetal macrosomnia?

A

clinician and maternal anxiety
labour dystocia
shoulder dystocia - more with diabetes
PPH

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

what is the management of foetal macrosomnia?

A

exclude diabetes
reassure
conservative vs IOL vs C/S delivery

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is polyhydramnios?

A

excess amniotic fluid

amniotic fluid index (AFI >25cm)
deepest pool >8cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the different causes of polyhydramnios?

A

maternal
- diabetes

foetal

  • 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
8
Q

what are the symptoms of polyhydramnios?

A 
abdominal discomfort 
pre-labour rupture of membranes
preterm labour 
cord prolapse 
PPH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are the signs of polyhydramnios?

A

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

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

how is polyhydramnios diagnosed?

A

USS

  • AFI >25
  • DVP >8cm

*this is subjective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what investigations should take place following diagnosis of polyhydramnios?

A

OGTT
serology - toxoplasmosis, CMV, parvovirus
antibody screen
USS - foetal survey (lips, stomach)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the management of polyhydramnios?

A

patient information of complications
serial USS - growth, LV, presentation
IOL by 40 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are the risks during labour in polyhydramnios?

A

risk malpresentation
risk of cord prolapse
risk of preterm labour
risk of PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the risk factors of multiple pregnancies?

A 
assisted conception - clomid, IVF
race - African 
family history 
increased maternal age 
increased parity 
tall women > short women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the difference between monozygotic and dizygotic twins?

A

monozygotic = splitting of a single fertilised egg (30%)

dizygotic = fertilisation of 2 ova by 2 spermatozoa (70%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what type of monozygotic twins occur which cleavage occurs at the following different stages:

a) morula (0-3 days)?
b) blastocyst (4-7 days)?
c) implanted blastocyst (8-14 days)?
d) formed embryonic disc (15 onwards)?

A

a) dichorionic / diamniotic (different placenta and amniotic sac)
b) monochorionic / diamniotic (same placenta, different inner membrane)
c) monochorionic / monoamniotic (both share placenta and membranes)
d) conjoined

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how can chorionicity be determined?

A

US

  • shape of membrane and thickness of membrane (twin peak at 11-13+6 weeks / CRL 45-84mm and placental masses, appearance of membrane attachment and thickness - Lambda sign)
  • foetal sex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why is determining chorionicity important?

A

monochortionic / monozygous twins at higher risk of complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are the symptoms of multiple pregnancy?

A

exaggerated pregnancy symptoms eg excessive sickness / hyperemesis gravidarum

20
Q

what are the signs of multiple pregnancy?

A

high AFP
large for dates uterus
multiple foetal poles

21
Q

when is USS confirmation of multiple pregnancy carried out?

22
Q

what are the fetal complications in multiple pregnancy?

A 
congenital anomalies eg acardiac twins 
IUD 
pre term birth 
growth restriction
cerebral palsy 
twin to twin transfusion - oligohydramnios & polyhydramnios
23
Q

what are the maternal complications in multiple pregnancy?

A 
HG
anaemia 
pre eclampsia 
antepartum haemorrhage (abruption, placenta praevia)
preterm labour 
c-section
24
Q

how often do multiple pregnancies attend clinic appointments for USS?

A

MC: every 2 weeks from 16/40
DC: every 4 weeks

25
what is the medical management in multiple pregnancies?
Fe supplementation low dose aspirin folic acid
26
what complications are specific to monochorionic twins?
single foetal death selective growth restriction (sGR) twin to twin transfusion syndrome (TTTS) twin anaemia-polycythaemia sequence (TAPS following laser ablation for TTTS) absent EDV or reversed EDV
27
what is twin to twin transfusion syndrome (TTTS)?
syndrome with artery-vein anastomoses donor twin perfuses the recipient twin *rare after 26/40
28
what is the diagnosis criteria of TTTS?
oligohydramnios - polyhydramnios
29
what are the complications of TTTS?
mortality >90% with no treatment | neurological morbidity 37% and high in surviving twin if IUD
30
what is the treatment of TTTS?
before 26/40 = fetoscopic laser ablation >26/40 = amnioreduction / septostomy deliver at 34-36/40
31
what is the timing of delivery of twins?
DCDA = 37-38 weeks MCDA = after 36 weeks with steroids MCMA = 32-34 weeks
32
what should the mode of delivery be for twins?
triplets or more = c-section MCMA = c-section twins if twin one cephalic = aim for vaginal delivery
33
what should be given after delivery of twin 1?
syntocinon
34
what are the complications of pre-existing diabetic pregnancies which all relate to poor control?
congenital anomalies - related to high HBA1C at booking misscarriage intra uterine death worsening diabetic complications eg retinopathy, neuropathy
35
what are the complications of diabetic pregnancies which are common to pre-existing and gestational diabetes?
``` pre eclampsia polyhydramnios macrosomnia shoulder dystocia neonatal hypoglycaemia ```
36
for type 1 and 2 diabetics, pregnancy should be avoided if HBA1C level is what?
above 86mmol/mol
37
what medications should be taken by type 1 and 2 diabetics?
folic acid 5mg | low dose aspirin from 12 weeks
38
what are the risk factors for gestational DM?
``` previous GDM obesity BMI 30 or more FH (1st degree relative) previous big baby polyhydramnios big baby glycosuria (1+ on >1 occasion or >=2+ on one occasion) ```
39
what is the pathophysiology of GDM?
pregnancy is diabetogenic - HPL, cortisol placental hormones - relative insulin deficiency / insulin resistance
40
what are the consequences of GDM?
overgrowth of insulin sensitive tissues and macrosomia hypoxaemic state in utero short term metabolic complications foetal metabolic reprogramming leading to increased long term risk of obesity, insulin resistance and diabetes
41
when should OGTT be carried out to screen for GDM?
risk factors at booking OGTT at 24-28 weeks
42
how is OGTT carried out in pregnant women?
venous FBS -> 75g glucose solution -> 2hr venous glucose
43
what are the potential advantages of oral hypoglycaemic agents?
avoidance of hypoglycaemia associated with insulin less weight gain less education required to ensure safe / effective administration
44
what should be the timing of delivery in diabetics?
pregestational - 38 weeks onwards - earlier if complications GDM - insulin treatment 38-39 weeks - metformin 39-40 weeks - diet alone 40-41 weeks - if foetal macrosomia / IUGR / PET then earlier delivery
45
what should be the mode of the delivery in diabetics?
maternal preference other indications for c-section discuss risks and benefits of vaginal birth inc shoulder dystocia (9-10% risk) if EFW >4.5kg - c section
46
what tests should be undertaken postnatally in GDM?
fasting blood sugar 6-8 weeks postnatally if picture of T2DM - OGTT 6 weeks PN annual FBS & lifestyle changes

Reproduction (45 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions