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3 Reproduction and Sexual Health > Large for Dates Pregnancies > Flashcards

Large for Dates Pregnancies Flashcards

1
Q

how do you work out if a pregnancy is large for date?

A

symphyseal fundal height >2cm

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2
Q

what country has the highest twinning rate in the world?

A

nigeria (african countries have a higher twin rate)

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3
Q

causes of LFD pregnancies?

A 
wrong dates
foetal macrosomia
polyhydramnios
diabetes
multiple pregnancy
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4
Q

when would you suspect LFD caused by low weight?

A

if mum has booked antenatal care late:
could be a concealed pregnancy
vulnerable woman
transfer of care from another district

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5
Q

define foetal macrosomia?

A

big baby

EFW >90th centile

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6
Q

risks for fetal macrosomia

A

anxiety
labour dystocia
shoulder dystocia
PPH

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7
Q

management of fetal macrosomia?

A

exclude diabetes
reassure
conservative vs IOL vs CS delivery

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8
Q

what does polyhydramnios look like on USS?

A

black (fluid is black)

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9
Q

what size pool of amniotic fluid indicates polyhydramnios?

A

> 8cm

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10
Q

define polyhydramnios?

A

excess amniotic fluid

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11
Q

amniotic fluid index > _cm indicates polyhydramnios

A

25

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12
Q

maternal causes of polyhydramnios

A

diabetes

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13
Q

foetal causes of polyhydramnios?

A 
anomaly eg GI atresia, cardiac
monochorionic twin pregnancy
hydrops fetalis
viral infection
idiopathic
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14
Q

presentation of polyhydramnios?

A

abdo discomfort
prelabour rupture of membranes
preterm labour
cord prolapse

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15
Q

Ix of polyhydramnios

A

OGTT to exclude diabetes
serology to exclude virus
antibody
USS

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16
Q

signs of polyhydramnios?

A

LFD
malpresentation
tense shiny abdomen
inability to feel foetal parts

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17
Q

incidence of twins ratio?

A

1:80

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18
Q

risk factors for multiple pregnancy?

A 
ART
african race
geography 
FH
increased maternal age
increased parity
tall women
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19
Q

dizygous twins have what chorionicity and what amnioticity?

A

dichorionic

diamniotic

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20
Q

monzygous twins can have what chorionicity and what amnioticity?

A

can be mono/dichorionic or mono/diamniotic

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21
Q

if twinning occurs very early (3 days) after fertilisation its likely the twins will be _chorionic and _amniotic

A

di

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22
Q

if twinning occurs within days 4-8 after fertilisation its likely the twins will be _chorionic and _amniotic

A

monochorionic

diamniotic

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23
Q

how is chorionicity determined?

A

shape and thickness of membrane on USS

foetal sex

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24
Q

__chorionic and __zygous twins are more at risk of pregnancy complications

A

mono

mono

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25
symptoms of multiple pregnancy
exaggerated pregnancy symptoms eg HG
26
signs of multiple pregnancy
high AFP large for dates uterus multiple foetal poles
27
when is multiple pregnancy confirmed on USS
12 weeks
28
foetal complications of multiple pregnancy?
``` congenital anomalies IUD preterm birth growth restriction cerebral palsy ```
29
maternal complications of multiple pregnancies?
``` HG anaemia preeclampsia entepartum haemorrhage preterm labour CS ```
30
how often is a pregnancy with monochorionic twins seen? from when?
every 2 weeks from 16 weeks
31
how often is a pregnancy with dichorionic twins seen?
every 4 weeks
32
antenatal Tx of mothers with multiple pregnancy?
iron supplementation low dose aspirin folic acid USS scans
33
Tx of oligohydramnios-polyhydramnios
before 26 wks - fetoscopic laser ablation | after 26 wks - amnioreduction/septostomy
34
what does monochorionic monoamniotic twins mean in utero?
they share a sac and a placenta
35
when should you deliver MCMA twins?
32-34 weeks by CS
36
when would you deliver DCDA twins?
37-38 weeks
37
when would you deliver MCDA twins?
after 36 weeks WITH STEROIDS
38
how would you deliver triplets?
always CS
39
how would you deliver twins?
SVD if first twin is normal (cephalic not breech), CS if first is breech
40
what Ix should be done in labour?
epidural USS and FSE syntocinon after twin 1 delivery USS to confirm presentation
41
what is the max time between twin deliveries?
30 mins
42
what birth complications are specific to pre-existing diabetes
congenital abnormalities miscarriage intrauterine death
43
what birth complications are common to pre-existing and gestational diabetes?
``` preeclampsia polyhydramnios macrosomia shoulder dystocia neonatal hypoglycaemia ```
44
target HbA1C for prepregnancy in diabetic women?
6.5% (48mmol/mol)
45
pregnancy should be avoided at what HbA1C?
10% (86mmol/mol)
46
what should be done in pre-pregnancy counselling of diabetic women?
stop teratogenic meds eg ACEi determine micro/macrovascular complications high dose folic acid 5mg advice
47
when is folic acid given in diabetic pregnant women?
3 months before conception to 12 weeks gestation
48
Tx of diabetes in pregnancy?
usual medication PLUS: folic acid 5mg low dose aspirin from 12 weeks
49
when should diabetic mum's babies be delivered?
38 weeks
50
how often are growth scans done in diabetes and when?
every month from 28 weeks
51
risk factors for GDM?
``` previous GDM BMI >30 FH asian/black ethnicity previous big baby polyhydramnios glycosuria 1+ on >1 occasion ```
52
how does DM harm baby?
placental hormones become insulin resistant overgrowth of insulin sensitive tissues and macrosomia fetal metabolic reprogramming increases long term risk
53
Ix of GDM
assess risk factors | OGTT 24-28 weeks (do in first trimester too if previous GDM)
54
fasting glucose over __mmol/l indicates GDM
5.1
55
2hr glucse over __mmol/l indicates GDM
8.5
56
target fasting glucose levels in GDM?
3.5-5.5mmol/l
57
target post-meal glucose levels should be under __mmol/l in GDM?
<7.8mmol/l
58
when should post-meal glucose levels be taken?
1 hour
59
how often should BGLs be taken per day?
4 times
60
if a patient has GDM and is on metformin when should you deliver?
39-40 weeks
61
if a patient has GDM and is on insulin when should you deliver?
38 weeks
62
how should a baby be delivered in GDM?
maternal preference (tell them the risks)
63
if EFW is >__kg do a c section
4.5

3 Reproduction and Sexual Health (51 decks)

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