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Reproduction and sexual health > Large for dates > Flashcards

Large for dates Flashcards

1
Q

What is the definition of large for dates

A

symphyseal fundal height >2cm for gestational age

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2
Q

list causes for being large for dates

A 
wrong dates
foetal macrosomia 
polyhydramnios 
diabetes mellitus
multiple pregnancy
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3
Q

What might happen if the dates are wrong

A

Late booker
concealed pregnancy
travelled from abroad

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4
Q

What does foetal macrosomia mean

A

big baby

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5
Q

How do you diagnose foetal macrosomia

A

USS scan
estimated foetal weight (EFW) >90th centile
abdominal circumference (AC) >97th centile

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6
Q

what are the risks of having a big baby

A

anxiety to mother and clinician
labour dystocia
shoulder dystocia
post partum haemorrhage

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7
Q

When is diagnosing foetal macrosomia most accurate

A

<38 weeks

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8
Q

USS overestimates baby’s size, true or false

A

TRUE

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9
Q

Management of foetal macrosomia

A

exclude diabetes
reassure
surveillance
discuss delivery options

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10
Q

if a baby is >4.5kg, what delivery option should be considered

A

c-section

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11
Q

What is polyhydramnios

A

excess amniotic fluid

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12
Q

How do you diagnose polyhydramnios

A

Amniotic Fluid index AFI > 25cm
Deepest Pool DP >8cm
Subjective impression

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13
Q

what are the causes for polyhydramnios

A

maternal: DM
foetal: anomaly, monochorionic twin pregnancy, hydrops fetalis, viral infection
idiopathic

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14
Q

Symptoms + signs of polyhydramnios in the mother

A 
Abdominal discomfort 
pre labour rupture of membranes 
pre term labour 
cord prolapse = obstetric emergency 
large for dates 
malpresentation 
tense shiny abdomen 
inability to feel foetal parts
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15
Q

Investigations for polyhydramnios

A

OGTT to exclude DM
USS - anomalies, multiple pregnancies
serology
Ab screen

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16
Q

Management of polyhydramnios

A

explain and discuss
surveillance
IOL by 40 weeks

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17
Q

Define multiple pregnancy

A

presence of more than 1 foetus in the uterus

twins, triplets etc

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18
Q

Risk factors for multiple pregnancy

A 
Assisted conception (less so now)
Ethnicity - African 
FH 
increased maternal age 
increased parity 
tall>short
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19
Q

How do monozygotic twins arise

A

splitting of single fertilised egg

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20
Q

How do dizygotic twins arise

A

from fertilisation of 2 separate ova by 2 separate sperm

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21
Q

Describe dichorionic-diamniotic twins

DCDA

A

2 placentas + 2 amniotic sacs
occurs in days 1-3
can occur in mono + dizygotic twins

22
Q

Describe monochorionic-diamniotic twins

MCDA

A

1 placenta + 2 amniotic sacs
occurs in days 4-8
monozygotic twins

23
Q

Describe monochorionic-monoamniotic twins

MCMA

A

1 placenta + 1 amniotic sac
occurs in days 8-13
monozygotic twins
at higher risk for complications

24
Q

Describe conjoined twins

A

Both babies are joined together

25
When is USS confirmation done for multiple pregnancy
12 weeks
26
What does the lambda sign on USS mean
DCDA twins
27
What does the T sign on USS mean
MCDA twins
28
What are symptoms and signs of multiple pregnancy in the mother
exaggerated symptoms eg hyperemesis gravidarum high AFP large for dates uterus multiple foetal poles
29
What are complications of multiple pregnancy
``` higher mortality congenital anomalies pre term birth growth restriction anaemia HG pre-eclampsia antepartum haemorrhage twin - twin transfusion syndrome TTTS twin anaemia polycythaemia sequence TAPS absent/reversed end diastolic volume ```
30
what is TTTS
arteriovenous anastamosis donor twin perfuses recipient twin oligohydramnios - polyhydramnios (oly-poly)
31
Management of TTTS
fetoscopic laser ablation amnioreduction / septostomy deliver at 34-36/40
32
When should DCDA twins be delivered
37-38 weeks
33
When and how should MCDA twins be delivered
after 36 weeks with steroids
34
How should MCMA twins be delivered
c-section
35
Objectives of multiple pregnancy delivery
``` consultant led epidural analgesia foetal monitoring oxytocin infusion after delivery of 1st baby intertwin time < 30 min be aware of PPH ```
36
What are types of diabetes in pregnancy
Pregestational - T1+2DM | Gestational - starts in pregnancy and resolves by delivery
37
Complications of pregestational DM only in pregnancy
congenital anomalies miscarriage intra uterine death worsening of diabetic complications - retinopathy, nephropathy
38
complications of both pregestational and gestational DM in pregnancy
``` pre eclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypoglycaemia ```
39
Above what HbA1c level should conception/pregnancy be avoided
HbA1c > 86 mmol/L
40
What HbA1c level should be aimed for pre conception
48mmol/L
41
What should be advised in pre pregnancy counselling for diabetics
Control HbA1c stop teratogenic drugs Folic acid 5mg
42
How do you manage T1DM in pregnancy
``` SC inulin low dose aspirin from 12/40 onwards 5mg folic acid continuous DM checks and screens growth scans every 4 weeks from 28/40 deliver at 38/40 ```
43
How do you manage T2DM in pregnancy
``` PO metformin (stop SURs!) low dose aspirin from 12/40 onwards 5mg folic acid continuous DM checks and screens growth scans every 4 weeks from 28/40 deliver at 38/40 ```
44
What are RF for GDM
``` previous GDM in previous pregnancy FH of DM BMI>30 ethnicity previous big baby polyhydramnios foetal macrosomia diagnosed glycosuria ```
45
How is OGTT carried out
venous fasting blood sugar taken give 75g glucose solution to drink minimal activity in 2 hour break measure 2 hour venous glucose
46
What are the SIGN guidelines for diagnosing GDM in OGTT
fasting glucose >5.1 | 2 hour glucose >8.5
47
How many times a day should blood glucose be checked
x4 /day
48
What are the glycaemic targets for fasting glucose 1 hour post meal
fasting glucose: 3.5-5.5 | 1 hour post meal <7.8
49
What delivery timings are advised in: 1. GDM with insulin 2. GDM with metformin 3. GDM with diet control
1. 38-39 weeks 2. 39-40 weeks 3. 40-41 weeks
50
How should GDM be followed up after delivery
fasting blood sugar measures 6-8 weekly | annual FBS and lifestyle changes

Reproduction and sexual health (46 decks)

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