ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI

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  1.  A 30-year-old pregnant female is undergoing routine blood tests . Pregnancy is associated with an increase in which of the following? A) Mean Cell Hemoglobin Concentration (MCHC) B) Serum ferritin concentration C) Hematocrit D) Total Iron Binding Capacity (TIBC) ✅ Answer: D) Total Iron Binding Capacity (TIBC) Explanation: Pregnancy leads to increased TIBC due to higher transferrin synthesis to compensate for increased iron demand. Serum ferritin and iron decrease due to increased iron utilization. Hematocrit reduces due to physiological hemodilution , not an actual decrease in RBC mass. DR MARIA RAFI ;923324747587 2.  A 28-year-old female, para 2+0 , presents with Hb 7 g/dL . What is the next best investigation? A) Hb electrophoresis   B) Total iron-binding capacity (TIBC) C) MCV and peripheral smear ✅ D) Serum iron Answer: A) Hb electrophoresis Explanation: The first step is to check MCV (Mean Corpuscular Volume) to classify anemia...
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What happens if your baby is measuring large for dates? NHS

 

Patient Information Leaflet

Large for Gestational Age (LGA)

What is a Large for Gestational Age (LGA) Baby?

🔹 Definition:

  • Babies weighing >4.5 kg (9 lbs 14.5 oz) at birth.
  • Defined as babies larger than 90th or 97th percentile on growth charts.

🔹 Individualized Growth Chart:

  • Created during your 12-week scan appointment, based on your height, weight, previous pregnancies, and ethnicity.

🔹 Prevalence:

  • About 5–8 out of 100 babies are identified as LGA.

Why Does it Matter if My Baby is LGA?

✅ Most large babies are healthy.
✅ 90% of women with LGA babies can have a vaginal birth.
⚠️ However, risks increase when:

  • Birthweight exceeds 4.5 kg.
  • Baby measures >97th percentile for gestational age on the growth chart.

What Causes a Baby to Be LGA?

  1. 🍭 Diabetes:

    • Pre-existing or gestational diabetes (GDM).

  2. 🤰 History of LGA Babies:

    • Previous baby weighing >4.5 kg at birth.

  3. ⚖️ Maternal Obesity/Overweight:

    • High BMI or excessive weight gain during pregnancy.

  4. 🧬 Genetics:

    • Parents who are taller or overweight tend to have larger babies.

  5. ⏳ Prolonged Pregnancy:

    • Gestation lasting 41 weeks or more.

What Are the Risks of Having an LGA Baby?

🌟 Most pregnancies with LGA babies are safe, but there are increased risks:

Maternal Risks:

  • 🏥 Cesarean Section (CS):
    • The likelihood of CS may double or more.
  • 🩸 Postpartum Hemorrhage (PPH):
    • Increased risk of significant blood loss after delivery.
  • 🧵 Perineal Tears:
    • Severe tears requiring stitches under anesthesia may be threefold higher, especially for first-time mothers.
  • ⏳ Delayed Labor Start:
    • Induction of labor (IOL) is more likely.

Neonatal Risks:

  • 💔 Shoulder Dystocia:
    • Baby’s shoulders may get stuck during delivery.
    • Occurs in 0.5% (1 in 200) of non-diabetic pregnancies.
  • 🦴 Birth Injuries:
    • Rarely, injuries like fractured clavicle (collarbone) or Erb’s Palsy (nerve damage).

How Do We Detect LGA Babies?

📊 Customized Growth Chart:

  • Tracks your baby’s expected growth pattern throughout pregnancy.

📏 Symphysis Fundal Height (SFH):

  • Measured at every antenatal visit after 26 weeks.
  • Plotted on the growth chart.

📷 Ultrasound Scan (USS):

  • Offered if SFH is larger than expected on two or more occasions.
  • Checks baby’s biometry (growth) and fluid volume.
  • Larger babies may have more fluid, but excessive fluid may indicate diabetes or infection.
    ⚠️ Accuracy decreases as pregnancy advances (10–15% error rate).

What Happens After the Assessment?

  1. Normal Growth:

    • Referred back to midwife for routine care.

  2. Suspected LGA Baby:

    • Glucose Tolerance Test (GTT):
      • Blood test to check for gestational diabetes.
      • Performed before 34 weeks (not reliable after this).
    • Consultant-led care beyond 34 weeks.

Induction of Labor (IOL)

  • 🔄 Routine: Offered at 39–40 weeks to reduce complications.
  • ⚖️ For Very Large Babies:
    • If EFW >5 kg or >97th percentile, cesarean section may be discussed.

What Happens During Labor?

  • 📈 Regular Monitoring:
    • Baby’s wellbeing and labor progress are continuously checked.
  • 🛑 Emergency Preparedness:
    • Midwives and doctors are trained to manage complications like shoulder dystocia or prolonged labor.

Is There Anything I Can Do to Reduce the Risk of an LGA Baby?

🌿 Healthy Lifestyle Choices:

  • Eat a balanced diet.
  • Engage in regular exercise.
    📞 Contact your midwife for personalized advice or a dietitian referral.

Summary

🔹 Large for Gestational Age (LGA): Refers to babies larger than most others at the same gestational age.
🔹 Key Points to Remember:

  • Most LGA babies are delivered safely.
  • Risks increase as weight or percentile rises.
  • Early identification and monitoring are crucial.
    🔹 Your Role: Maintain a healthy lifestyle and communicate with your healthcare team.






REFERENCES  National Institute for Health and Care Excellence, CG62 ‘ Antenatal Care for Uncomplicated Pregnancies’, March 2008. 

 National Institute for Health and Care Excellence, CG63 ‘ Diabetes in Pregnancy: Management from preconception to postnatal period’ February 2015. 

 NHS Choices: The UKs biggest health website, certified as a reliable source of health information- www.nhs.uk 

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ANEMIA IN PREGNANCY : MCQS AND IMPORTANT MCQS By DR MARIA RAFI

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