LGA

Question 1

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Discuss your approach to this patient

Answer 1

History
Examination
Differential for LGA
Investigations
Management of GDM
Management of ROM and cord prolapse
Salbutamol contraindications
Advice at discharge

Question 2

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

History

Answer 2

Obs hx
Rest of hx
BF

Question 3

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Examination

Answer 3

Weight, height, MUAC
Mild oedema
Fetus

Question 4

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Differential diagnosis for LGA

Answer 4

Polyhydramnios
Multiple pregnancy
Macrosomia
Pelvic mass
Incorrect dates
Incorrect measurement

Question 5

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Investigations

Answer 5

Sonar - fetal anatomy (stomach bubble, NTD, congenital infection)
TORCH screen
GDM rapid screen
75g 2hr OGTT

Question 6

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Management of GDM

Answer 6

1. Refer to high risk clinic
2. F/U 2weekly
3. Dietician
4. Metformin/insulin regimen
5. Glucometer
6. Monitor fetus
7. Consider amniodrainage
8. Deliver at 38w

Question 7

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Management of ROM and cord prolapse

Answer 7

1. Call for help
2. Prep for C/S
3. Elevate presenting part off cord
4. Position (steep Trendelenburg/knee chest)
5. Place cord in vagina
6. Insert Foley’s and fill bladder - relieve clamp when C/S incision
7. Tocolysis 500ug salbutamol in 100ml NaCl - give 2ml over 2min min

Question 8

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Salbutamol contraindications

Answer 8

Maternal

• tachycardia
• cardiac disease
• asthma
• hyperthyroidism
• beta blocker usage

Question 9

26yo P0G1 from local clinic at 26w GA with Rh + booked at 16w. SFH = 32cm.

Discharge advice

Answer 9

BF
Contraception
Family spacing
Wound care
Removal of suture
Lifestyle modification
Redo OGTT in 6w -> F/U yearly
Screen for GDM next pregnancy