Small & Large For Dates

Question 1

Give a differential for LFD

Answer 1

Wrong date
Fetal macrosomia
Polydramnio
DM
Multiple pregnancy

Question 2

What is the definition of macrosomia?

Answer 2

Estimated fetus weight EFW >90th centile

on customised growth chart

Question 3

What is the commonest pathological cause of macrosomia?

Answer 3

Maternal diabetes

Question 4

What are the risks of macrosomia?

Answer 4

Labour complications eg >PPH, >shoulder dystocia

Question 5

What is the definition of low birth weight?

Answer 5

Birth wt <2.5kg regardless of gestation

Question 6

What is more common, monozygotic or dizygotic twins

Answer 6

Dizygotic (70%)

Question 7

What causes dizygotisity?

Answer 7

2 ova + 2 sperm

Question 8

What causes monozygosity?

Answer 8

1 fertilised egg splits

Question 9

What does DCDA stand for and what does it mean?

Answer 9

Dichorionic diamniotic
2 placentas, 2 amniotic cavities
(MCMA just 1)

Question 10

What type of twins are always DCDA?

Answer 10

Dizygotic

Question 11

Are monozygotic twins DCDA, MCDA, MCDA or DCDA?

Answer 11

Can be any

Question 12

How many days post fertilisation would a fertilised egg split to produce DCDA monozygotic twins?

Answer 12

0-3 days

Question 13

How many days post fertilisation would a fertilised egg split to produce MCDA monozygotic twins?

Answer 13

4-7 days

Question 14

How many days post fertilisation would a fertilised egg split to produce MCMA monozygotic twins?

Answer 14

8-14 days

Question 15

What happens if a fertilised egg splits >15 days post fertilisation?

Answer 15

Conjoined twins

Question 16

The normal S+S of pregnancy, such as hyperemesis, are increased in multiple pregnancy. T or F.

Answer 16

True

Question 17

In multiple pregnancy, if one of the babies is breech, a caesarian is indicated. T or F

Answer 17

False, only if both babies breech

Question 18

Multiple pregnancy is more common in [old/young] and [multi/nulliparous] mums

Answer 18

Old
Multiparous

(Also more common in ACT and +ve FH)

Question 19

At what antenatal visit is multiple pregnancy confirmed?

Answer 19

12 week scan

can see chorionicity

Question 20

When should you aim to deliver DCDA monozygotic twins?

Answer 20

37-38wk

Question 21

When should you aim to deliver MCDA monozyogtic twins?

Answer 21

36wk

Question 22

In multiple pregnancy delivery, how quickly should you aim to deliver baby 2 after baby 1?

Answer 22

Less than 30min

IJ synctocinon after baby 1

Question 23

All multiple pregnancies should be given low dose aspirin LDA as prophylaxis for PET. T or F

Answer 23

True

also give Fe supplement

Question 24

What condition of the amniotic fluid is more common in multiple pregnancy?

Answer 24

Oligohydramnios

Question 25

What is oligohydramnios?

Answer 25

Insufficient / decreased amniotic fluid vol

Question 26

What is polyhydramnios?

Answer 26

Excess amniotic fluid

Question 27

Polyhydramnios can cause _____ membrane rupture.

Answer 27

early

Question 28

What might be found on antenatal abdominal exam in polyhydramnios?

Answer 28

Tense shiny abdo Hard to palpate baby (also abdo discomfort and LFD)

Question 29

An US AFI amniotic fluid index greater than 25 is indicative of _______

Answer 29

polyhydramnios

Question 30

In the Mx of polyhydramnios, labour should be induced by ____ weeks

Answer 30

40

Question 31

What is gestational diabetes?

Answer 31

Diabetes where the onset or first recognition occurs in pregnancy

Question 32

How is gestational diabetes screening for?

Answer 32

OGGT at 28 weeks | Done in 1st trimester if PTx has a PMH

Question 33

What are the targets of fasting glucose in gestational diabetes?

Answer 33

3.5 - 5.9

Question 34

What are the targets of glucose less than 1 hour after eating?

Answer 34

<7.8

Question 35

How frequently should BG be measured in GDM?

Answer 35

4X day

Question 36

What is the management of GDM diagnosed at 40weeks gestation?

Answer 36

Diet alone

Question 37

What is the Mx of GDM diagnosed at 39-40wk gestation?

Answer 37

Metformin

Question 38

What is the Mx of GDM diagnosed before 38 wk gestation?

Answer 38

Insulin

Question 39

For mothers with GDM, if the EFW is bigger than _____, a caesarean is indicated

Answer 39

4.5kg

Question 40

What are the indications for induction of labour IOL in GDM?

Answer 40

Macrosomia IUGR PET

Question 41

What complication of vaginal delivery is more common in GDM?

Answer 41

Shoulder dystocia

Question 42

Neonates of mothers with GDM are at risk of _____ following birth

Answer 42

Hypoglycaemia

Question 43

6-8 weeks postnatally, mothers with GDM should get a ______

Answer 43

BG test

Question 44

Define SGA small for gestational age

Answer 44

EFW estimated fetal wt <10th centile

Question 45

How do you classify SGA?

Answer 45

Constitutionally small or Intrauterine growth restriction IUGR

Question 46

How can SGA be screened for on examination?

Answer 46

Measure symphysis-fundal height every 2-3 week from 24wk, plot on centile

Question 47

If SGA has been recorded, what's size should be measured on US at 26-28 weeks?

Answer 47

Fetal and umbilical artery size

Question 48

What assessment of the fetus is performed whilst investigating SGA?

Answer 48

Biophysical assessment BPP

Question 49

SGA is a risk factor for [high/low] bilirubin?

Answer 49

High

Question 50

If a fetus is SGA, but growth is continuing and the biophysical assessment BPP is satisfactory, what is the management?

Answer 50

Deliver at 37 weeks - give Mg sulfate and CCS