Question 6: LGA

Question 1

1. What should the height of fundus be at 20 weeks gestation?

Answer 1

20

Question 2

2. Given that the fundus is high for dates what further history would be important to try and help lead towards a likely cause of this finding?

Answer 2

Confirm validity of dates (LMP - accuracy, regularity, length. Dating scan?)

Confirm 1x fetus on USS, if twins - chorionicity?

Risk fx for polyhydramnios (diabetes, fetal anomalies/abnormal anatomy)

Fibroids?

BMI

Question 3

3. What features would you ask a sonographer to review when requesting an ultrasound scan?

Answer 3

Fetal anatomy, growth, doppler, liquor volume, placenta, pelvic pathology e.g. fibroids

Question 4

4. If a multiple pregnancy is diagnosed what are the implications (maternal and fetal) of this which will lead you to adjust your further follow up?

Answer 4

Maternal:
HTN, preeclampsia, gest diabetes, hyperemesis, physiological demand increased, anaemia, antenatal haemorrhage or PPH

risk of CS

Fetal: risk of IUGR, pre-term birth
twin-to-twin transfusion syndrome, breech, complex delivery (two fetuses)

Management:
Need to confirm chorionicity and amniocity

More frequent scanning may be required - e.g. SGA guidelines.
Monochoriconic - fortnightly from 16 weeks.