Large for gestational age Flashcards
What is large for gestational age?
Weight of the newborn is more than 4.5kg at birth; during pregnancy, estimated foetal weight above 90th centile is considered large for gestational age.
Aetiology of LGA?
- Foetal macrosomia
- Polydramnios - excess amniotic fluid
- Maternal diabetes
- Maternal obesity
- Multiple pregnancy
- Monozygotic-splitting of single fertilised egg.
- Dizygotic-fertilisation of 2 ova by spermatozoa.
- Chorionicity- 1 or 2 placentas
What is monozygotic multiple pregnancy?
Twins derived from a single ovum resulting in them being identical (splitting of single fertilised egg).
What is dizygotic multiple pregnancy?
Twins derived from 2 separate ova resulting in them not being identical.
Why is chorionicity important to determine and how is this determined?
Carried out via USS since monozygous twins are at higher risk of pregnancy complications.
Symptoms of multiple pregnancy?
Exaggerated pregnancy symptoms e.g. excessive sickness/hyperemesis gravidarum
Signs of multiple pregnancy?
- High AFP (alpha-fetoprotein)
- Large for dates uterus
- Multiple foetal poles
Investigations for LGA?
Ultrasound is main imaging examination
Multiple pregnancy complications of LGA?
- Foetal complications include congenital anomalies, IUD, pre-term birth, growth restriction, cerebral palsy.
- Maternal complications include hyperemesis gravidarum, anaemia and pre-eclampsia.
Foetal macrosomia complications of LGA?
- Clinician and maternal anxiety
- Labour dystocia (caused by large or awkwardly positioned foetus)
- PPH (postpartum haemorrhage)
Management of foetal macrosomia?
• Exclude diabetes
• Reassure
• Conservative vs IOL (induction of labour) vs C/S delivery
Management for polyhydramnios in LGA?
- IOL (induction of labour) by 40 weeks
- Risks during labour include malpresentation, cord prolapse and
PPH - Neonatal examination
Management for multiple pregnancy in LGA?
Twin/multiple pregnancy clinic
Maternal education
Medications - iron, low dose aspirin, folic acid.
Increased USS surveillance
What are foetal poles?
one of the first stages of an embryo’s development in pregnancy
Becomes apparent at week 6 gestation
Function of the foetal pole?
the fetal pole has the head of the embryo at one end and a tail-like structure at the other.
The distance between these two points is used to measure the crown-to-rump length (CRL), which helps determine how far along you are in your pregnancy.
