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Large for dates Flashcards

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1
Q

what is large for dates

A

symphyseal-fundal height >2cm for gestational age

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2
Q

causes of large for dates

A 
wrong dates 
foetal macrosomia 
diabetes 
multiple pregnancy 
Polyhydramnios
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3
Q

causes for late booking in pregnancy

A

concealed pregnancy
vulnerable women
transfer of care eg. booked abroad

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4
Q

what is foetal macrosomia

A

‘big baby’

USS estimated foetal weight >90th gentile

abdominal circumference >97th percentile

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5
Q

risks of macrosomia

A

clinician and maternal anxiety

labour dystocia (baby physically cant get out)

shoulder dystocia (after head gets out, the anterior shoulder gets stuck behind the pubic bone)

post partum haemorrhage

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6
Q

what is the margin of error for ultrasound estimated foetal weight

A

10%

eg. could estimate 4000g but its actually 3600g

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7
Q

how do you manage macrosomia

A

exclude diabetes
reassure
Birth plan eg. conservative vs induction of labour vs caesarean section

induction of labour should not be carried out for macrosomia unless there are other indications

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8
Q

what is Polyhydramnios

A

excess amniotic fluid

Amniotic fluid index >25cm

Deepest pool >8cm

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9
Q

causes of Polyhydramnios

A

Maternal Diabetes

Anomaly- GI atresia, cardiac, tumours

Monochorionic twin pregnancy

hydros fetalis (accumulation of fluid in the foetus)

viral infection

idiopathic

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10
Q

how does Polyhydramnios present

A

Abdominal discomfort
Pre-labour rupture of membranes
Pre-term labour
Cord prolapse

Signs: 
large for dates 
malpresentation 
tense shiny abdomen 
inability to feel fatal parts
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11
Q

how do you investigate Polyhydramnios

A

Ultrasound
Amniotic fluid index >25
Deepest vertical pocket >8cm
Survey fetus

Oral glucose tolerance test
Serology - toxoplasmosis, CMV, parvovirus
Antibody screen

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12
Q

how do you manage Polyhydramnios

A

Inform patient fo complications
Serial USS -growth, presentation
Induce labour by 40 weeks

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13
Q

risks in labour caused by Polyhydramnios

A

Malpresentation
Cord collapse
Preterm labour
Post partum haemorrhage

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14
Q

what is a multiple pregnancy

A

more than one foetus - twins, triplets etc

spontaneous twins 1/80
spontaneous triplets 1/10,000
increased with assisted conception

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15
Q

what increases the risk of multiple pregnancy

A 
Assisted conception 
Race - African 
Geography - more common in Nigeria, less common in Japan and china 
FH
Increased maternal age 
Increased parity (have had kids before) 
Tall women>short women
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16
Q

what are monozygotic twins

A

splitting of a single fertilised egg

30% of twins

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17
Q

what are dizygotic twins

A

fertilisation of 2 ova by 2 sperm

70% of twins

always dicorchionic/diamniotic

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18
Q

what are dichorionic twins

A

twins that have 2 placentas

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19
Q

what are monochorionic twins

A

twins that share a placenta

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20
Q

what are monoamniotic twins

A

twins that share 1 amniotic sac

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21
Q

what are diamniotic twins

A

twins that have their own amniotic sacs

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22
Q

what combinations of chronicity and amnionicity can you get

A

Dichorionic/diamniotic
(2 placentas, 2 amniotic sacs) - get in dizygotic twins or day 3

Monochorionic/diamnionic
(1 placenta, 2 amniotic sacs)
-monozygotic twins that split on days 4-7

Monochorionic/monoamniotic
(1 placenta, 1 amniotic sac)
-monozygotic twins that split on days 8-14

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23
Q

what determines chronicity/amnionicity

A

time of splitting off of fertilised ovum in monozygotic twins

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24
Q

what days do monozygotic twins split to be conjoined

Study These Flashcards
A

days 13-15

or >day 15

25
monozygotic twins that split day 3
dichorionic/diamniotic | DCDA
26
monozygotic twins that split days 2-7
monochorionic/diamniotic | MCDA
27
monozygotic twins that split days 8-14
monochorionic/monoamniotic | MCMA
28
monozygotic twins that split >15 days
conjoined
29
how do you determine chorionicity
Ultrasound -shape of membrane and thickness of membrane Foetal sex
30
what type of twins are at highest risk of pregnancy complications
Monochorionic monozygous twins
31
ultrasound sign for DCDA twins
Lambda sign | curve in membrane as it is two separate ones coming together
32
ultrasound sign for MCDA twins
T sign Thick at top = single placenta Thin down the middle - divides the two amniotic sacs
33
symptoms of multiple pregnancy
Exaggerated symptoms of pregnancy eg- excessive sickness/hyperemesis gravidarum
34
signs of multiple pregnancy
High AFP Large for dates uterus Multiple foetal poles Confirm via ultrasound at 12 weeks
35
Foetal complications of multiple pregnancy
Higher perinatal mortality (6x higher than singleton) Congenital anomalies Intrauterine death (one or both) Preterm birth Growth restriction (one or both) Cerebral palsy (twins 8x higher, triplets 47x higher) twin to twin transfusion (causes Oligohydramnios and Polyhydramnios)
36
Maternal complications of multiple pregnancy
``` Hyperemesis Gravidarum Anaemia Pre eclampsia Antepartum haemorrhage - abruption, placenta praaevia Preterm labour C-section ```
37
how often are appointments needed with a consultant for twins
Monochorionic - every 2 weeks (including USS) | dichorionic - every 4 weeks including USS
38
what medications are given to mothers with multiple pregnancies
Iron supplements Low dose aspirin Folic acid
39
complications of monochorionic twins
Single foetal death Selective growth restriction Twin-twin transfusion syndrome Twin anaemia Absent EDV (end diastolic flow) or reversed end diastolic flow - sign of cardiac stress on foetus/placental insufficiency
40
what is twin-to-twin transfusion syndrome
Artery vein anastomoses Donor twin perfuses recipient twin rare after 26 weeks causes Oligohydramnios and Polyhydramnios
41
complications to twin-twin transfusion syndrome
mortality >90% | neurological morbidity 37% and high in surviving twin if intrauterine death
42
treatment for twin-twin syndrome
<26 weeks - Fetoscopic laser ablation >26 weeks - Amnioreduction/septostomy deliver 34-36 weeks
43
when would you deliver dichorionic diamniotic twins
37-38 weeks
44
twin would you deliver monochorionic monoamniotic twins
36 weeks with steroids
45
how do you deliver triplets or more
c-section
46
how do you deliver monochorionic monoamniotic twins
c-section
47
how do manage labour for twins
``` consultant led epidural fetal monitoring syntocinon after twin 1 USS to comfirm presentation Intertwin delivery time needs to be <30 mins risk of PPH ```
48
what types of diabetes do you get in pregnancy
Pregestational type 1 type 2 MODY Gestational
49
complications of pre-existing diabetes in pregnancy
Related to poor control congenital abnormality (related to high HBA1C before booking) Miscarriage Intrauterine death Worsening diabetic complications eg. retinopathy, nephropathy
50
complications of gestational and pre-existing diabetes in pregnancy
``` Pre eclampsia Polyhydramnios Macrosomnia Shoulter dystocia Neonatal hypoglycaemia ```
51
Pre-pregnancy counselling for diabetes
aim for HBA1C to be 48mmol/mol (avoid pregnancy if >86) stop teratogens eg. ACEis Determine macro and micro vascular complications high dose folic acid 3 months before conception to 12th week general diabetes advice
52
risk factors for gestational diabetes
``` Previous GDM BMI >30 FH Previous big baby Polyhydramnios Glycosuria current big baby ```
53
how is gestational diabetes caused
placental hormone cause relative insulin deficiency/insulin resistance this leads to overgrowth of insulin sensitive tissues in the foetus - macrosomnia hyperaemic state in utero foetal metabolic reprogramming leading to increase in long term risk of obesity, insulin resistance and diabetes
54
how do you screen for gestational diabetes
oral glucose tolerance test in 1st trimester, then repeated at 24-28 weeks diagnostic values fasting glucose >5.1 2 hour glucose >8.5
55
management of gestational diabetes
diet, weight and exercise control growth scans use hypoglycaemic agents when diet and exercise fail to maintain targets
56
when do you deliver a baby if mother has pregestational diabetes
>38 weeks
57
when do you deliver a baby is there is gestational diabetes
on metformin 38-39 weeks diet alone 40-41 weeks if fetal macrosomia earlier delivery
58
what is the risk of future development of type 2 diabetes if the mother has had gestational diabetes
70% Fasting blood sugar done 6-8 weeks postnatally

3 Reproduction (49 decks)

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