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Obs and Gynae > large for dates > Flashcards

large for dates Flashcards

(50 cards)

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1
Q

what is large for date?

A

Symphyseal-fundal height >2cm for Gestational age

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2
Q

Causes of large for date?

A

Wrong dates
Fetal Macrosomia
Polydramnios
Diabetes
Multiple Pregnancy
(Obesity)

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3
Q

fetal macrosomia- what?

A

big baby

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4
Q

how is fetal macrosomia diagnosed?

A

USS EFW >90th centile
AC>97TH Centile

AC- abdominal circumference
EFW- estimated fetal weight

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5
Q

Risks related to fetal macrosomia?

A

-clinican + maternal anxiety
-labour dystocia
-shoulder dystocia (more with diabetes)
-PPH (post partum haemorrhage)

shoulder dystocia= babies should trapped behind pubic synphesis

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6
Q

problems with using USS for ESF?

A

-Ultrasound ESF is commonly overestimated
-USS More accurate <38 weeks
-Influenced by BMI of women (harder if higher)
-Operator dependant

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7
Q

Management- fetal macrosomia?

A

-Exclude diabetes
-Reassure

If EFW>/=5kg offer c/section

NICE Recommendation: In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic).

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8
Q

what is polyhamdramnios?

A

Excess amniotic fluid

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9
Q

criteria for diagnosis of POLYHADRIMNIOS?

A
  • Amniotic Fluid Index (AFI >25cm)

Deepest Pool >8cm

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10
Q

maternal risks for polyhadriminios?

A

more likely with diabetes

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11
Q

fetal risks for polyhadriminios?

A

-Anomaly (GI atrsia, cardiac, tumour)
-Monochorionic twin pregnancy
- Hydrops fetalis (Rh isoimmunisation)
-Viral infection (erythrovirus B19, Toxoplasmosis, CMV)
-Idiopathic

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12
Q

presentation for polyhadriminios?

A

Most are asymptomatic

Symptoms
-Abdominal discomfort
-Pre-labour rupture of membranes
-Preterm labour
-Cord prolapse

Signs
-LFD
- Malpresentation
- tense shiny abdomen
-inability to feel fetal parts

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13
Q

investigations for polyhadriminios?

A

DIAGNOSTIC:
Amniotic Fluid Index (AFI) >25cm
Deepest Pool >8cm

USS fetal survey to look at babys:
-lips
-stomach

Exclude risk factors:
OGTT - to exclude maternal diabetes
Serology to exclude viral infection- toxoplasmosis, CMV, Parvovir
Antibody screen

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14
Q

Management for polyhadriminios?

A

-IOL by 40 weeks

Serial USS- growth, LV, presentation

-Neonatal examination

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15
Q

risks in labour for polyhadriminios?

A

Risks during labour:
-malpresentation
-cord prolapse
-Preterm Labour
-PPH

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16
Q

what increases risk of multiple pregnancy?

A

Increased with:
-Assisted conception
-African women
-FH
-increased materanal age
-increased parity
-Tall women> small women

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17
Q

monozygotic- what?

A

splitting of a single fertilised egg

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18
Q

dizygotic- what?

A

fertilisation of 2 ova by spermatozoa

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19
Q

Chorionicity -what?

A

1 or 2 placentas

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20
Q

why is it important to identify monozygotic, dizygotic or chorionicity on USS?

A

important to determine via USS because monochorionic/monozygous twins are at higher risk of pregnancy complication

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21
Q

when would splitting have to occur to have monochorionic twins?

Study These Flashcards
A

Monochorionic will occur if splitting happens after 4-7 days

22
Q

investigations for multiple pregnancy?

Study These Flashcards
A

Multiple pregnancy - confirmed at 12 weeks
-Shape of membrane and thickness of membrane (twin peak at 11-13 + 6 weeks with CRL 45-84mm)
-Fetal sex
-Chorionicity

23
Q

when is the US scan to check for multiple pregnancy?

24
Q

symptoms/ signs of multiple pregnancy?

Study These Flashcards
A
  • Symptoms
    • Exaggerated pregnancy symptoms e.g. excessive sickness/ hyperemesis gravidarum
  • Signs
    • High AFP
    • Large for dates uterus
    • Mutiple fetal poles

USS confirmation at 12 weeks

25
complications for fetus in multiple pregnancy?
Fetal includes congenital anomalies, IUD, pre-term birth, growth restriction, cerebral palsy, twin to twin transfusion
26
complications for mother in multiple pregnancy?
Maternal include hyperemesis gravidarum, anaemia, pre eclapsia
27
complications of monochorionic twins?
Single Fetal Death Selective Growth Restriction (sGR) Twin-To- Twin Transfusion Syndrome (TTTS) Twin Anaemia- P0lycythaemia Sequence (TAPS) Abnormal Dopplers: Absent EDF (AEDF) or Reversed EDF (REDF)
28
at what point does splitting occur for monochorionic twins
Monochorionic will occur if splitting happens after 4-7 days
29
what is twin to twin transfusion
Syndrome with artery-vein anastomoses. Donor twin perfuses the recipient twin
30
risks of twin to twin transfusion?
More common in monochorionic/ monozygotic twins Rare after 26/40
31
what is seen on USS- twin to twin transfusion?
USS: -Oligohydramnios -polyhydramnios (Oly-Poly)
32
Management- twin to twin transfusion?
Before 26/40 –fetoscopic laser ablation >26/40- amnioreduction /septostomy Deliver 34-36/40
33
complications- twin to twin transfusion?
Untreated, TTTS has a high mortality rate for both twins, with the donor more likely to survive * Mortality >90% with no treatment Neurological morbidity 37% and high in surviving twin if IUD
34
why do both foetus in twin to twin transfusion risk developing heart failure and hydrops?
- Both foetuses are at risk of developing heart failure and hydrops - The donor suffers high output cardiac failure as a consequence of severe anaemia and the recipient suffers fluid overload
35
how are conjoined twins managed?
Conjoined twins: -MDT -specialised centres
36
maangement- Monochorionic Monoamniotic?
-deliver by C/section 32-34 weeks -higher risk of foetal death due to risk of cord entanglemnt
37
what what point are DCDA twins delivered?
37 to 38 weeks
38
what what point are MCDA twins delivered?
>36 weeks with steroids
39
how are triplets delivered
cesarean
40
how are MCMA (monochorionic monoamniotic) delivered?
ceserean section
41
gestational diabetes- what?
carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy
42
whats different in gestational diabetes compared to regular?
* Increases insulin requirements * N&V can precipitate DKA * Ketosis more common * Diabetic retinopathy worsens especially after rapid control of diabetes Diabetic Nephropathy can worsen
43
RISKS- gestational diabetes
-BMI above 30 kg/m2 -previous macrosomic baby weighing 4.5 kg or above -previous gestational diabetes -family history of diabetes (first‑degree relative with diabetes) -minority ethnic family origin with a high prevalence of diabetes
44
investigation for gestational diabetes?
Screening first line= oral glucose tolerance test (OGTT) Fasting >=5.1 mmol/l 2 hour >=8.5 mmol/l
45
who is screened for gestation diabetes?
OGTT is used in patients with risk factors for gestational diabetes, and also when there are features that suggest gestational diabetes: -Large for dates fetus -Polyhydramnios -Glucose on urine dipstick RISKS: -BMI above 30 kg/m2 -previous macrosomic baby weighing 4.5 kg or above -previous gestational diabetes -family history of diabetes (first‑degree relative with diabetes) -minority ethnic family origin with a high prevalence of diabetes
46
how often should women with gestational diabetes check blood glucose?
measure blood glucose 4x daily: -fasting (pre breakfast) -postmeals (1 hour or 2 hours post meal) -before bed
47
glycaemic targets- gestational diabetes?
Fasting 3.5-5.5mmol/l 1hr <7.8mmol/l 2hr <6.4mmol/l
48
At what estimated fetal weight should C section be done for gestational diabetes?
>4.5kg
49
what risk does breast feeding have - diabetes?
hypoglycaemia
50
what risk does breast feeding have - diabetes?
hypoglycaemia

Obs and Gynae (60 decks)

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