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Flashcards in Big for dates Deck (18)
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1
Q

causes for large pregnancies

A

wrong dates
multiple preg
diabetes
polyhydramnios

2
Q

what is polyhydramnios

what are the causes

A

excess amniotic fluid

monochorionic twins preg
fetal anomaly
maternal diabetes
hydrops fetalis - Rh isoimmunisation infection
idiopathic
3
Q

what are the signs and symptoms of polyhydramnios

what is the diagnosis

A

discomfort, labour , membrane rupture, cord prolapse

US, clinical

4
Q

multiple pregnancy incidence

where is there a higher incidence of multiple preg

A

spontaneous twins 1:80
triplets 1:10000

higher incidence in infertility programmes

5
Q

what does zygosity mean
what does chrionicity mean

why are these terms important in multiple preg

A

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
Q

how can we tell chrionicity before birth

A

US

  • shape of membrane and thickness of membrane - twin peak at 12 weeks
  • fetal sex
7
Q

Multiple pregnancy diagnosis

signs/symptoms

A

usually US at 12 weeks

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

8
Q

multiple pregnancy complications

A
higher perinatal mortality due to 
congenital anomalies
pre term labour 
growth restriction 
pre eclampsia 
antepartum haemorrhage 
twin to twin transfusion syndrome
9
Q

multiple pregnancy manegemtns

A
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
Q

multiple pregnancy delivery

A

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

11
Q

consequences of gestation diabetes

A

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
Q

gestational diabetes screening and dx

A

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
Q

gestational diabetes risk factors

A
FH of DB
previous big baby 
previous unexplained still birth 
recurrent glycosuria 
maternal obesity 
previous gestational diabetes
14
Q

debates in preg - complications

A

all related to poor control

congenital anomalities, miscarriage, intra uterine death

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

15
Q

target levels for mum

A

fasting 3.5-3.9

1 hour post prandial <7.8

16
Q

advantages to oral hypoglycaemic over insulin in mothers

A

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

17
Q

regular monitoring for what should be done

A

pre eclamptic toxaemia

18
Q

risk of future development of type 2 diabetes in mothers

A

up to 70%

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