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obstetrics > 20) Preterm fetus. Small for gestational age. > Flashcards

20) Preterm fetus. Small for gestational age. Flashcards

1
Q

what is SGA (small for gestational age)

A

it is low birth weight for gestational age

commonly defined as a weight below the 10th percentile for the gestational age

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2
Q

normal weight during term delivery is ?

A

2500-4200g

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3
Q

foetuses are separated into 3 different categories after birth what are they ?

A

low birth weight - below 2500g regardless of their gestational age

small for gestational age- foetuses maturation does not correspond to gestational age

premature foetuses - born before 37 weeks of gestation

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4
Q

all IGUR are ?

A

SGA - birth weight less than 10 percentile of theavergae gestational age

but not all SGA are IUGR - can be due to small mother small baby - they have no increased obstetric or neonatal risk

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5
Q

risks factors for SGA

A

IUGR

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6
Q

IUGR etiology can be grouped into 4 main categories?

A

maternal , placental and fetal , and combination of all these (which is the main cause)

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7
Q

maternal causes if IUGR ?

A 
poor nutritional intake , smoking , drug abuse 
alcoholism 
renal diseases
antiphospholipid syndrome
essential hypertension
 chronic renal disease
eclampsia / preeclampsia

advanced diabetes with vascular
involvement

narrow pelvis

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8
Q

what is antiphospholipid syndrome?

A

autoantibody production
provoking blood clots - in placenta or uterus

diagnosis requires one clinical event such as thrombosis / pregnancy complication

and two - antibody blood testing - conforming the presence of lupus anticoagulant or anti b2 glycoprotein -1

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9
Q

treatment for antiphospholipid syndrome?

A

heparin - safe in pregnancy

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10
Q

placental causes of IUGR ?

A 
vilamentous cord insertion 
cord knots 
cord prolapse 
bilobed placenta 
placental abruption
reduced placental size
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11
Q

fetal causes causes of IUGR ?

A

intrauterine infections - listeriosis TORCH
toxoplasmosis , cytomegalovirus herpes

congenital anomalies - chromosomal abnormalities

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12
Q

what are the different types of clinical appearances of IUGR ?

A

symmetrical and asymetrical

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13
Q

what is symmetrical IUGR ?

A

both the body, length and the head growth is inadequate

ponderal index
birth weight / higher cm3 = >2 symmetrical IUGR

poor prognosis

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14
Q

symmetrical IUGR caused by ?

A

occurring very early in pregnancy

intrauterine infections - TORCH
and congenital fetal anomalies

pathological process is intrinsic to the fetus and involves all organs

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15
Q

what is asymmetrical IUGR ?

A

head is spared and larger than the abdomen

ponderal index
birth weight / height = <2
(>2.5 aga)

uncomplicated prognosis

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16
Q

when does asymmetrical IUGR occur ?

and what causes it ?

A

late in pregnancy

maternal diseases / placental and cord problems - reducing uteroplacental blood flow

17
Q

diagnosis of IUGR

A

fundal height is 3cm below according to what the gestational age should be

maternal weight stationary and sometimes falling in second term

======

US - BIOPHYSICAL

gestational age first determined

4) head to abdominal circumference ratio
In a normally growing fetus the HC/AC ratio exceeds 1.0 before 32 weeks. It is approximately 1.0 at 32 to 34 weeks. After 34 weeks, it falls below 1.0.

. In symmetric IUGR, both the HC and AC are reduced.

(asymmetrical HC larger) hc:ac >1

5) Femur length (FL) is not affected in asymmetric IUGR. The FL/AC ratio is 22 at all gestational ages from 21 weeks to term. FL/AC ratio greater than 23.5 suggests IUGR

abdominal crcumference <10 percentile

7) amniotic fluid volume
reduction - correlates with asymmetrical
if single deepest pocket <1cm = IUGR

amniotic fluid index - measuring the largest pockets of fluid found in each of the four quadrant
AFI <5cm = oligohydroamnios

8) fetal weight CALculation formula

====

9) umbilical and uterine artery , MCA artery doppler flow study

Reduced or absent or reversed end diastolic velocity (AREDV) in the umbilical artery indicates fetal jeopardy

Middle cerebral artery (MCA): Increased diastolic velocity (brain sparing effect) is observed in a compromised fetus.

aberrant middle cerebral artery to umbilical artery doppler pulsate index

18
Q

clinical management of IUGR antenatal ?

A

once fetus has been declared having decreased growth - attention to modification of environmental and social factor that can be changed

Adequate bedrest, especially in left lateral position;

extra calories per day are to be taken;

Maternal hyperoxygenation

these patients should be electronically monitored for any signs of fetal distress at all times - NST , biophysical profiling, kick count , amniotic fluid vol

======
Pregnancy ≥ 37 weeks: Delivery should be done.

for cases of severe IUGR with strong US evidence of it -
delivery indicated at usually 34-37wks or gestational age as soon as the lung has reached its maturity .
corticosteroids given to speed it.

Delivery done at 34 gestation in cases of FGR with additional risk factors for adverse perinatal outcome= Preeclampsia, oligohydramnios

if deliver has to be done before 32 weeks, magnesium sulfate should be given
for fetal and neonatal neuroprotection

C section is preferred because its has no tolerance to asphyxia
or
Low rupture of the membranes followed by oxytocin is employed in cases such as pregnancy beyond 34 weeks with favorable cervix and the head is deep in the pelvis.

19
Q

clinical management of neonate with IUGR ?

A

after birth the new born should be checked to rule out any :
infections

congenital anomalies

chromosome abnormality - trisomy 18

blood gas analysis
monitoring of blood glucose levels because the fetus does not have adequate hepatic glycogen
polycythmia - Polycythemia may occur when SGA fetuses experience chronic mild hypoxia caused by placental insufficiency. Erythropoietin release is increased

all SGA babies should be watched for signs of Failure-to-
thrive

endocrinologist should be consulted. Some cases warrant growth hormone therapy

20
Q

Hypoglycemia complication is common in which type of SGA

A

asymmetrical SGA babies because their larger brains burn calories at a faster rate than their usually limited fat stores hold

21
Q

most asymmetrical SGA catch up their growth in ?

A

the first two years of life and have a normal adult height

22
Q

what happens to infants infants who are significantly small due to illness of the mother

A

do not reach a normal height as compared to other

23
Q

what is the morphology of a baby in SGA?

A

dry and wrinkled skin because of less subcutaneous fat,

scaphoid abdomen,

thin meconium stained vernix caseosa

thin umbilical cord.

Pinna of ear has cartilaginous ridges.

Plantar creases are well defined

All these give the baby an “old-man look”.

24
Q

what are the complication in SGA ?

A

Asphyxia,

bronchopulmonary dysplasia and RDS.

Hypoglycemia

Meconium aspiration syndrome

hypothermia

25
Q

how do we know if a baby is Appropriate for Gestational Age

A

Birth weight lies between the 10th and 90th percentiles for gestational age

26
Q

how do we know if it is large for gestational age ?

A

s birth weight above the 90th percentile for gestational age

27
Q

what is the definition of a preterm baby ?

A

baby born before 37 completed weeks of gestation

usually weigh 2500 g or less

length is usually less than 44 cm

28
Q

what is the classification for preterm birth according to gestational age

A

full term - 39-40weels

early term - 37-38 weeks

========

moderate to late preterm - 32wks to 36 weeks and 6

very preterm -28 to 31 weeks and 6 days weeks

extremely preterm less than 28 weeks

VIABLE GESTATIONAL AGE -24

29
Q

anatomically what is the morphology of a preterm baby ?

A

The head circumference disproportionately exceeds that of the chest

abdomen relatively large

Pinnae of ears are soft and flat.

The eyes are kept closed

skin is thin, wrinkly , red and shiny, due to lack of subcutaneous fat

lack of lanugo

Muscle tone is poor.

Plantar deep creases are not visible before 34 weeks.

The testicles are undescended;

small labia major and prominent labia minora and clitorios prominent

30
Q

what is the prognosis of preterm baby ?

A

A baby weighing more than 1500 g is most likely (95%) to survive

ADHD

31
Q

management of preterm baby /

A

warm incubators were temp and
humidification to counter the water loss is controlled

ET and mechanical ventilation with
or cpap
pulse oximeter

iv fluid and electrolytes

sterility kept for infections
and prophylactic antibiotics

early feeding
through tube / pipette or spoon / bottle / IV

iv started <1200g and less than 30 weeks

1200-1800 - tube feeding

> 1800 (>34wks) breast

32
Q

favourable sign of progress in preterm baby

A

The color of the skin remains pink all the time.

(2) Smooth and regular breathing.
(3) Increasing vigor evidenced by—movements of the limbs and cry.
(4) Progressive gain in weight

obstetrics (44 decks)

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