Large for dates

Question 1

what is foetal macrosomia

Answer 1

big baby

Question 2

what diagnoses foetal macrosomia

Answer 2

USS estimated foetal weight >90th centile

Question 3

causes of large for date

Answer 3

diabetes
polydramnios 
multiple pregnancy 
obesity 
foetal macrosomia

Question 4

risks with large baby

Answer 4

dystocia - risk of shoulder getting stuck on way out of birth canal

Question 5

what is polyhydramnios

Answer 5

excess amniotic fluid

Question 6

causes of polyhydramnios

Answer 6

maternal diabetes 
foetal anomaly 
monochorionic twin pregnancy 
hyrops fetalis (Rh isoimmunisation, infection
idiopathic

Question 7

clinical features of polyhydramnios

Answer 7

abdo discomfort
pre-labour rupture of membranes (labour)
cord collapse

Question 8

how to diagnose polyhydramnios

Answer 8

clinically
tense shiny abdomen
unable to feel foetal parts

Question 9

what does ultrasound show

Answer 9

AFI >25

DVP >8

Question 10

when should polyhydramnios patients have had an induction of labour by

Answer 10

40 weeks

Question 11

what increases incidence of multiple pregnancy

Answer 11

assisted conception
familial 
increased maternal age 
increased parity 
tall

Question 12

what is monozygotic twins

Answer 12

share singular fertilized egg q

Question 13

what is dizygotic twins

Answer 13

fertilization of 2 eggs by 2 sperm

Question 14

what is more common, monozygotic or dizygotic twins

Answer 14

dizygotic

Question 15

what is monozygous twins

Answer 15

separate sac and own placenta

NON-IDENTICAL

Question 16

what is dizygous twins

Answer 16

share a sac and placenta

IDENTICAL

Question 17

how do you determine chorionicity

Answer 17

USS - shape of membrane and thickness of membrane
12 weeks
mono - thinner T sign
di - thicker, lambda sign

Question 18

what type of twins are at higher risk of complications

Answer 18

monochorionic monozygous

Question 19

symptoms of multiple pregnancy

Answer 19

exaggerated pregnancy symptoms (hyperemesis)

Question 20

investigations showing multiple pregnancy

Answer 20

high AFP
large for date uterus
multiple foetal poles

Question 21

complications of multiple pregnancy to foetuses/neonates

Answer 21

perinatal mortality 
congenital anomalies 
intrauterine death 
pre-term birth 
growth restriction
cerebral palsy 
twin-twin transfusion (polyhydramnios)

Question 22

when should multiple pregnancy get a detailed congenital anomaly scan

Answer 22

18 weeks

Question 23

maternal complications of multiple pregnancy

Answer 23

anaemia 
hyperemesis gravidarum 
pre-eclampsia 
antepartum haemorrhage 
pre-term labour 
C section

Question 24

medications during pregnancy for multiple pregnancy

Answer 24

iron supplements
low dose aspirin
folic acid

Question 25

mode of delivery for triplets or more

Answer 25

C section

Question 26

how should twins be delivered if one has cephalic presentation

Answer 26

aim for vaginally

Question 27

definition of gestational diabetes

Answer 27

carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

Question 28

complications of pre-existing diabetes in pregnancy

Answer 28

congenital anomalies miscarriage intrauterine death

Question 29

complications of both pre-existing and gestational diabetes

Answer 29

``` pre-eclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypoglycaemia ```

Question 30

what medication should be stopped in diabetes pre-conception

Answer 30

ace inhibitors cholesterol lowering agents any other embryopathic meds

Question 31

what medication should be given to diabetic patients in pregnancy

Answer 31

high dose folic acid - 3 months before conception to 12 weeks of pregnancy low dose aspirin

Question 32

risk factors for gestational diabetes

Answer 32

``` previous gestational diabetes obesity FH ethnicity previous big baby glycosuria ```

Question 33

pathophysiology of gestational diabetes

Answer 33

hormones released from the placenta cause insulin deficiency/resistance

Question 34

diagnostic criteria for gestational diabetes

Answer 34

fasting OGTT >=5.1 | 2 hour OGTT >=8.5

Question 35

when should hypoglycaemic agents be considered in gestational diabetes

Answer 35

diet and exercise fail to maintain targets | macrosomia on USS

Question 36

risk factors for postnatal development of type 2 diabetes

Answer 36

obesity | use of insulin during pregnancy