7: Problems in pregnancy - large for dates

Question 1

What centiles are babies likely to be above/below if they are

a) large for dates
b) small for dates?

Answer 1

a) > 90th centile
b) < 10th centile

Question 2

What is the definition of a large-for-dates baby?

Answer 2

Fundal height > 2cm greater than expected for gestational age

Question 3

What is an innocent reason for a large-for-dates baby?

Answer 3

Mother has given the wrong dates

i.e can’t remember when her last pregnancy was, or has concealed it

Question 4

Is macrosomia always caused by diabetes?

Answer 4

No, can occur on its own to produce a large-for-dates baby

Question 5

What are three reasons for a large-for-dates pregnancy?

Answer 5

Multiple pregnancy

Foetal macrosomia

Gestational diabetes (causing macrosomia)

Polyhydramnios

Wrong dates given

Question 6

How is foetal weight estimated?

Answer 6

Using ultrasound measurements - abdominal circumference and femur length

Question 7

Macrosomia describes a foetus above which weight centile?

Answer 7

> 90th centile

Question 8

What disease must you exclude in foetal macrosomia?

Answer 8

Maternal diabetes

Question 9

What does dystocia mean?

Answer 9

Obstructed birth

e.g large-for-dates babies who can’t squeeze through the birth canal

Question 10

What complication of pregnancy, causing brachial plexus injury or clavicle fracture, may occur in macrosomic babies?

Answer 10

Shoulder dystocia

Question 11

What are the three options in managing foetal macrosomia?

Answer 11

Conservative - wait for due date and see what happens

Induction of labour

Caesarean section

Question 12

What is polyhydramnios?

Answer 12

Excess amniotic fluid

Question 13

How is excess amniotic fluid detected?

Answer 13

Abdominal examination - increased fundal height, increased liqour

Ultrasound measurements

Question 14

What amniotic fluid index on ultrasound is diagnostic of polyhydramnios?

Answer 14

> 25cm

Question 15

What is the depth of amniotic fluid diagnostic of polyhydramnios on ultrasound?

Answer 15

> 8cm

Question 16

What is the

a) amniotic fluid index
b) pool depth

diagnostic of polyhydramnios?

Answer 16

a) API > 25cm

b) Deepest pool > 8cm

Question 17

What endocrine disease can cause polyhydramnios?

Answer 17

Maternal diabetes

This seems like a safe answer for any problem in pregnancy tbh

Question 18

Which type of pregnancy may cause polyhydramnios?

Answer 18

Multiple pregnancy

Question 19

Polyhydramnios can cause __-__ labour.

Answer 19

pre-term labour

i.e premature birth

Question 20

What is the main symptom of polyhydramnios?

Answer 20

Abdominal pain

Question 21

What are the physical signs of polyhydramnios?

Answer 21

Tense, shiny abdomen

Inability to feel foetal parts

Excess liquor

Question 22

What test should be done for all patients with suspected diabetes?

Answer 22

2 hour OGTT following overnight fast

This is the standard Ix in pregnant women with suspected gestational diabetes

Question 23

If a patient with polyhydramnios hasn’t given birth by 40 weeks, how should it be managed?

Answer 23

Induction of labour

Question 24

What is the definition of multiple pregnancy?

Answer 24

Presence of > 1 foetus in the womb

Question 25

What **infertility therapy** increases a woman's chances of **multiple pregnancy**?

Answer 25

**Assisted conception therapy**

Question 26

Why does **ACT** increase a woman's chances of multiple pregnancy?

Answer 26

**Multiple embryos/zygotes can be artificially to increase chances of success** **But if \> 1 of those are successful then multiple pregnancy occurs**

Question 27

People from which part of the world are more likely to have multiple pregnancies?

Answer 27

**Sub-Saharan Africa**

Question 28

What is the cause of **monozygotic twins?**

Answer 28

**Splitting of one fertilised egg**

Question 29

What is the cause of **dizygotic twins?**

Answer 29

**Two separate ova fertilised by two separate spermatozoa**

Question 30

Apart from **zygosity**, what other factor are twins described in terms of?

Answer 30

**Chorionicity** i.e if there are one or two placentas

Question 31

**Dizygous twins** always have ___ placenta(s) and ___ amniotic cavity / cavities.

Answer 31

**dizygous twins --\> two placentas, two amniotic cavities** i.e **DCDA** (dichorionic diamniotic)

Question 32

What **four forms** can **monozygous twins** develop in?

Answer 32

**DCDA** - two placentas, two amniotic cavities **MCDA** - shared placenta, two amniotic cavities **MCMA** - shared placenta, shared amniotic cavity **Conjoined**

Question 33

What factor decides the **form** that **monozygotic twins** will develop in?

Answer 33

**Point after fertilisation at which split occurs**

Question 34

Which **imaging technique** can be used to determine the **chorionicity** of twins?

Answer 34

**Ultrasound**

Question 35

Which **sign**, found on ultrasound, can be used to **differentiate DCDA and MCDA twins?**

Answer 35

**Lambda sign** Shows there are two placentas with a membrane between them

Question 36

Why is it important to know the **zygosity** and **chorionicity** of a **twin pregnancy?**

Answer 36

**Different forms of twin pregnancy have different complication risks**

Question 37

What is a possible **symptom** of multiple pregnancy?

Answer 37

**Exaggerated morning sickness**

Question 38

Which hormone maintains the **corpus luteum** during pregnancy?

Answer 38

**hCG**

Question 39

What happens to **hCG** **levels** during multiple pregnancy?

Answer 39

**hCG levels are higher than normal**

Question 40

Why is **multiple pregnancy** dangerous?

Answer 40

**Increased risk of maternal and foetal complications**

Question 41

Which dietary supplement is optional in most pregnant women but **required** in **multiple pregnancy?**

Answer 41

**Iron** due to risk of anaemia

Question 42

Which **anti-platelet** is given to women with multiple pregnancy? Why?

Answer 42

**Aspirin** To reduce risk of pre-eclampsia

Question 43

Which **dietary supplement** is given to pregnant women to reduce the risk of their babies having neural tube defects?

Answer 43

**Folic acid**

Question 44

Which **scan** are women with multiple pregnancy regularly given?

Answer 44

**Ultrasound scan**

Question 45

What **complication** of monochorionic pregnancy results in one twin having **polyhydramnios** and the other having **oligohydramnios?**

Answer 45

**Twin-twin transfusion syndrome**

Question 46

**Multiple pregnancies** are often delivered by which method?

Answer 46

**Caesarean section**

Question 47

In what **forms** can a pregnant women have diabetes?

Answer 47

**Either pre-existing Type 1, Type 2 diabetes or MODY** Or pregnancy-onset **gestational diabetes**

Question 48

What are the complications of **poorly-controlled diabetes**, no matter its form, in **pregnant women?**

Answer 48

**Pre-eclampsia** **Polyhydramnios** **Macrosomia** and **shoulder dystocia** **Neonatal hypoglycaemia** **Miscarriage**

Question 49

What are the **common complications** of diabetes which need to be monitored for in pregnant women?

Answer 49

**Macrovascular disease** **Microvascular disease** - retinopathy, neuropathy, nephropathy

Question 50

What is the **HbA1c target** in pregnant women?

Answer 50

**\< 48 mmol/mol**

Question 51

If a **woman's HbA1c** is \> ___ mmol/mol, they should avoid getting pregnant.

Answer 51

**\> 86 mmol/mol** (or 10 units)

Question 52

Which **folic acid** dose are **women** given if they have **pre-existing diabetes** and want to get pregnant?

Answer 52

**5mg** As opposed to 400 micrograms for everyone else

Question 53

The **greater a pregnant woman's \_\_\_,** **the greater her chances of developing diabetic complications.**

Answer 53

**greater HbA1c = greater complication risk**

Question 54

Which drug are **pregnant women** given if they are at increased risk of vascular complications?

Answer 54

**Aspirin**

Question 55

What diseases does **gestational diabetes** increase a woman's chances of developing post-partum?

Answer 55

**Type 2 diabetes** **Obesity** **Cardiovascular disease**

Question 56

Which test is used to diagnose gestational diabetes?

Answer 56

**2h OGTT**

Question 57

How is **gestational diabetes** managed?

Answer 57

**Manage lifestyle** (diet, exercise) as much as you can **Regular BG monitoring** **Metformin** OR **Insulin injections / pump**

Question 58

Which form of delivery avoids **shoulder dystocia** in macrosomic babies?

Answer 58

**Caesarean section**

Question 59

When is the target delivery gestation for women with pre-existing diabetes?

Answer 59

**38 weeks**

Question 60

How often do women with pre-existing diabetes receive foetal ultrasound scans during pregnancy?

Answer 60

**Every 4 weeks from 28 weeks**