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Flashcards in Big for dates Deck (18):
1

causes for large pregnancies

wrong dates
multiple preg
diabetes
polyhydramnios

2

what is polyhydramnios
what are the causes

excess amniotic fluid

monochorionic twins preg
fetal anomaly
maternal diabetes
hydrops fetalis - Rh isoimmunisation infection
idiopathic

3

what are the signs and symptoms of polyhydramnios
what is the diagnosis

discomfort, labour , membrane rupture, cord prolapse

US, clinical

4

multiple pregnancy incidence
where is there a higher incidence of multiple preg

spontaneous twins 1:80
triplets 1:10000

higher incidence in infertility programmes

5

what does zygosity mean
what does chrionicity mean

why are these terms important in multiple preg

zygosity refers to number of eggs fertilised to produce twins

c - refers to the membrane pattern of the twins

monochorionic/monozygous twins at higher risk of pregnancy complications

6

how can we tell chrionicity before birth

US
- shape of membrane and thickness of membrane - twin peak at 12 weeks
-fetal sex

7

Multiple pregnancy diagnosis
signs/symptoms

usually US at 12 weeks

exaggerated preg symptoms - excessive sickness
high AFP
large for dates uterus
feeling more than two fetal poles

8

multiple pregnancy complications

higher perinatal mortality due to
congenital anomalies
pre term labour
growth restriction
pre eclampsia
antepartum haemorrhage
twin to twin transfusion syndrome

9

multiple pregnancy manegemtns

more frequent antenatal visits
detailed anomaly scan at 18 weeks
regular scans from 28 weeks for growth
routine iron supplementation
warning to mother regarding risk and signs of pre term labour

10

multiple pregnancy delivery

triplets or more require a c section
twins - vaginal delivery
greater risk with c section
epidural analgesia

11

consequences of gestation diabetes

overgrowth of insulin sensitive tissues and macrosomia
hyperaemic state in utero
short term metabolic complications
fetal metabolic reprogramming leading to increase long term risk of obesity, insulin resistance and diabetes

12

gestational diabetes screening and dx

screened based on risk factors of random blood glucose at booking and 28 weeks gestation
dx based on GTT at 28 weeks
dx values fasting >=5.1
2 hour >=8.5

13

gestational diabetes risk factors

FH of DB
previous big baby
previous unexplained still birth
recurrent glycosuria
maternal obesity
previous gestational diabetes

14

debates in preg - complications

all related to poor control

congenital anomalities, miscarriage, intra uterine death

pre eclampsia, polyhydramnios, macrosomia, shoulder dystocia, neonatal hypoglycaemia

15

target levels for mum

fasting 3.5-3.9
1 hour post prandial <7.8

16

advantages to oral hypoglycaemic over insulin in mothers

avoidance of hypos assoc with insulin
less weight gain
less education required to ensure safe/effective administration

17

regular monitoring for what should be done

pre eclamptic toxaemia

18

risk of future development of type 2 diabetes in mothers

up to 70%
obesity, use of insulin during pregnancy, fasting glucose levels during preg, IGT post partum, ethnic group