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Y3 Reproductive > Small & Large For Dates > Flashcards

Small & Large For Dates Flashcards

1
Q

Give a differential for LFD

A 
Wrong date
Fetal macrosomia
Polydramnio
DM
Multiple pregnancy
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2
Q

What is the definition of macrosomia?

A

Estimated fetus weight EFW >90th centile

on customised growth chart

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3
Q

What is the commonest pathological cause of macrosomia?

A

Maternal diabetes

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4
Q

What are the risks of macrosomia?

A

Labour complications eg >PPH, >shoulder dystocia

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5
Q

What is the definition of low birth weight?

A

Birth wt <2.5kg regardless of gestation

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6
Q

What is more common, monozygotic or dizygotic twins

A

Dizygotic (70%)

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7
Q

What causes dizygotisity?

A

2 ova + 2 sperm

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8
Q

What causes monozygosity?

A

1 fertilised egg splits

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9
Q

What does DCDA stand for and what does it mean?

A

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

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10
Q

What type of twins are always DCDA?

A

Dizygotic

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11
Q

Are monozygotic twins DCDA, MCDA, MCDA or DCDA?

A

Can be any

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12
Q

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

A

0-3 days

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13
Q

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

A

4-7 days

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14
Q

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

A

8-14 days

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15
Q

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

A

Conjoined twins

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16
Q

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

A

True

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17
Q

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

A

False, only if both babies breech

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18
Q

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

A

Old
Multiparous

(Also more common in ACT and +ve FH)

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19
Q

At what antenatal visit is multiple pregnancy confirmed?

A

12 week scan

can see chorionicity

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20
Q

When should you aim to deliver DCDA monozygotic twins?

A

37-38wk

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21
Q

When should you aim to deliver MCDA monozyogtic twins?

A

36wk

22
Q

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

A

Less than 30min

IJ synctocinon after baby 1

23
Q

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

A

True

also give Fe supplement

24
Q

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

A

Oligohydramnios

25
Q

What is oligohydramnios?

A

Insufficient / decreased amniotic fluid vol

26
Q

What is polyhydramnios?

A

Excess amniotic fluid

27
Q

Polyhydramnios can cause _____ membrane rupture.

A

early

28
Q

What might be found on antenatal abdominal exam in polyhydramnios?

A

Tense shiny abdo
Hard to palpate baby

(also abdo discomfort and LFD)

29
Q

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

A

polyhydramnios

30
Q

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

A

40

31
Q

What is gestational diabetes?

A

Diabetes where the onset or first recognition occurs in pregnancy

32
Q

How is gestational diabetes screening for?

A

OGGT at 28 weeks

Done in 1st trimester if PTx has a PMH

33
Q

What are the targets of fasting glucose in gestational diabetes?

A

3.5 - 5.9

34
Q

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

A

<7.8

35
Q

How frequently should BG be measured in GDM?

A

4X day

36
Q

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

A

Diet alone

37
Q

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

A

Metformin

38
Q

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

A

Insulin

39
Q

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

A

4.5kg

40
Q

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

A

Macrosomia
IUGR
PET

41
Q

What complication of vaginal delivery is more common in GDM?

A

Shoulder dystocia

42
Q

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

A

Hypoglycaemia

43
Q

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

A

BG test

44
Q

Define SGA small for gestational age

A

EFW estimated fetal wt <10th centile

45
Q

How do you classify SGA?

A

Constitutionally small
or
Intrauterine growth restriction IUGR

46
Q

How can SGA be screened for on examination?

A

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

47
Q

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

A

Fetal and umbilical artery size

48
Q

What assessment of the fetus is performed whilst investigating SGA?

A

Biophysical assessment BPP

49
Q

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

A

High

50
Q

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

A

Deliver at 37 weeks - give Mg sulfate and CCS

Y3 Reproductive (28 decks)

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