Large For Dates Flashcards

Question

when can multiple pregnancy be confirmed?

Answer 1

US scan at 12 weeks

Answer 2

``` congenital abnormalities IUD (single/both) pre-term birth growth restriction cerebral palsy twin to twin transfusion (oligohydramnios and polyhydramnios) ```

Answer 3

``` hyperemesis gravidarum anaemia pre-eclampsia antepartum haemorrhage (abruption, placenta praevia) preterm labour caesarean section ```

Answer 4

``` consultant lead care twin/multiple pregnancy clinic clinic appointments - every 2 weeks if Monochorionic - every 4 weeks if DC give maternal education ```

Answer 5

iron supplement low dose aspirin folic acid

Answer 6

``` every 2 weeks from 16 weeks look for anomaly at 18-20 weeks look at deep vertical pool bladder and umbilical artery doppler EFW ```

Answer 7

single fetal death (also involves risk to surviving twin) selective growth restriction twin to twin transfusion syndrome (TTTS) twin anaemia-polycythaemia sequence (TAPS) absent EDV (AEDV) or reversed (REDV)

Answer 8

unequal blood counts between twins in the womb (form of TTTS) can follow fetoscopic laser ablation for TTTS?

Answer 9

twin to twin transfusion syndrome (TTTS)

Answer 10

syndrome with artery-vein anastamosis donor twin perfuses the recipient twin (rare after 26 weeks)

Answer 11

oligohydramnios of one amniotic sac (low amniotic fluid) and polyhydramnios of the other (high amniotic fluid)

Answer 12

mortality >90% without treatment | 37% neurological morbidity

Answer 13

if before 26 weeks = fetoscopic laser ablation if over 26 weeks = amnioreduction/septostomy deliver at 34-36 weeks

Answer 14

risk for cord entanglement higher risk of fetal death should be delivered by C section at 32-34 weeks

Answer 15

monochorionic monoamniotic twins conjoined twins higher order births (trichorionic twins, monochorionic dichorionic twins)

Answer 16

``` timing - DCDA = 37-38 weeks - MCDA = after 36 weeks with steroids mode of delivery - triplets or more = C/section - MCMA = C/section - twins = if twin one cephalic, aim for vaginal delivery ```

Answer 17

``` ocnsultant lead epidural anaesthesia feal monitoring (US and FSE) syntocinon after twin 1 US to confirm presentation intertwin delivery time <30 mins risks of PPH - active 3rd stage ```

Answer 18

if pre-existing diabetes - congenital anomalies (related to high HBA1C) - miscarriage - intra-uterine death - worsening diabetes complications (retinopathy, nephropathy)

Answer 19

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

Answer 20

monitor HBA1C (aim for 48) avoid pregnancy if HBA1C >86 stop any embryopathic medication (eg ACE inhibitors, cholesterols lowering drugs) determine macrovascular and microvascular complications high dose folic acid 5mg 3 months before and after conception advice about diabetes and hypoglycaemia contraception

Answer 21

early booking 5mg folic acid low dose aspirin from 12 weeks fetal anomaly scan at 18-20 weeks regular eye checks for retinopathy refer to renal team if nephropathy present give hypoglycaemic agents (insulin MDI/pump, metformin) consider continuous glucose monitoring growth scans 4 weekly from 28 weeks counsel about shoulder dystocia deliver at 38 weeks (earlier if complications)

Answer 22

``` previous gestational diabetes BMI >30 family history (in 1st degree relative) south asian, middle eastern, black caribbean previous big baby polyhydramnios big baby seen on US glycosuria ```

Answer 23

pregnancy hormones cause diabetes | - placental hormones cause relative insulin deficiency/insulin resistance

Answer 24

overgrowth of insulin sensitive tissues and macrosomnia hypoxaemic state in utero short term metabolic problems fetal metabolic reprogramming leading to increased long term risk of obesity and diabetes

Answer 25

``` look at risk factors at booking if previous GD - monitor BG - or OGTT 1st trimester and repeat at 24-28 weeks if normal always do OGTT at 24-28 weeks anyway ```

Answer 26

measure venous FBS give 75g glucose solution measure 2 hr venous glucose (they should have minimal physical activity between tests)

Answer 27

fasting = 5.1 2 hour = 8.5 (NICE is different)

Answer 28

fasting = 3.5-5.5 mmol/L 1 hr post meal = <7.8mmol/L should measure blood glucose minimum 4 times per day (premeal/1 hr post meal/before bed)

Answer 29

avoidance of hypoglycaemia associated with insulin less weight gain less education required to ensure safe administration

Answer 30

``` pre-existing - 38 weeks onwards - earlier if complications gestational - insulin treatment 38-39 weeks - metformin 39-40 weeks - diet alone 40-41 weeks - if fetal macrosomnia/IUGR/PET earlier delivery ```

Answer 31

maternal preference other indication for C/section should discuss risks and benefits of vaginal birth (shoulder dystocia) C/section if EFW >4.5kg

Answer 32

future development of type 2 diabetes is likely risk factors - obesity - use of insulin during pregnancy - fasting glucose levels from OGTT during pregnancy can indicate risk - IGT post partum - ethnic group should do fasting blood sugar 6-8 weeks after birth do OGTT 6 weeks after birth if picture of type 2 diabetes annual FBS and lifestyle changes

Answer 33

malpresentation cord prolapse preterm labour PPH (post partum haemorrhage)