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Year 2 LCRS RDA > 4b: Intra-Uterine growth Restrictions > Flashcards

4b: Intra-Uterine growth Restrictions Flashcards

1
Q

What is Small for gestational Age? (SGA)?

A

he infant has a birth weight <10th centile (also called ‘Small for dates’).

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2
Q

What is IntraUterine growth resticion (ICGR)?

A

Failure of the infant to achieve its predetermined (genetic) potential for a variety of reasons

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3
Q

Define Low Birth weight

A

Less than 2,500g at delivery. Currently ~7% of live births (UK).

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4
Q

Define Very low birth weight

A

Less than 1,500g at delivery. Currently ~1% of live births (UK).

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5
Q

Define Extremetly low birht weight

A

Less than 1,000g at delivery. Currently ~0.2% of live births (UK).

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6
Q

When trying to define babies with IUGR, which percintiles to you use as guidance?

A

Depending on what you want

  1. 10th centile: high sensitivity (will pick up all babies) but also many healthy
  2. 3rd centile: highly specific but will miss IUGR babies
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7
Q

How can IUGR be assessed?

A

should only be used for fetuses with definite evidence that growth has altered

–> Percentile deviation from series of observations should be used!

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8
Q

What are the different outcomes that might happen from IUGR

A

Widely increases change of stillbirth

  • subsequent pregnagncies might also be affected and have an increased riks
  • increased numer of complications:
    • short term
    • medium term
    • long term
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9
Q

What are the short term probems of IUGR?

A
  • Respiratory distress
  • Intraventricular haemorrhage
  • Sepsis
  • Hypoglycaemia
  • Necrotising enterocolitis
  • Jaundice (when loosing weight)
  • Electrolyte imbalance
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10
Q

What are the medium-term consequences of IUGR?

A
  • Respiratory problems
  • Developmental delay
  • Special needs schooling
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11
Q

What are the long term problems of IUGR?

A

Fetal programming –> might still have problems in adut life

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12
Q

When do IUGR ususally develop?

A

Usually in 2nd and 3rd trimester (where most growht happens)

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13
Q

What are the main categories of factors that can influence IUGR

A
  1. Maternal Behaviour
  2. Maternal Medical factors
  3. Fetal factors
  4. Placental Factors
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14
Q

Which maternal medical factors might lead to the developent of IUGR?

A
  • Chronic hypertension
  • Connective tissue disease
  • Severe chronic infection
  • Diabetes mellitus
  • Anaemia
  • Uterine abnormalities
  • Maternal malignancy
  • Pre-eclampsia
  • Thrombophilic defects
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15
Q

What is pre-eclampsia?

What is the consequence

A

Condition that is characterised by

  • development of Maternal HTN
  • And Proteinuria
  • After 20 weeks
  • Cause unknown but
    • fibrous spiral arteries –> abnormal placenta
      • leading to inflammation –>
      • endothelial alteraltion of maternal organs leading to vasoconstriction
  • Might lead to IUGR and miscarriage, displacement of placenta
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16
Q

What are maternal behavioural factors that might cause IUGR?

A
  • Smoking
  • Low booking weight (<50 kg)
  • Poor nutrition
  • Age <16 or >35 years at delivery
  • Alcohol
  • Drugs
  • High altitude
  • Social deprivation
17
Q

What are fetal factors that might lead to IUGR?

A
  • Multiple pregnancy
  • Structural abnormality
  • Chromosomal abnormalities
  • Intrauterine (congenital) infection
  • Inborn errors of metabolism
18
Q

What are placental factos that might lead to IUGR?

A
  • Impaired trophoblast invasion
  • Partial abruption or infarction
  • Chorioamnionitis
  • Placental cysts
  • Placenta praevia
19
Q

How is pre-eclampsia managed?

A

Very hard to treat so main aim:

  • Monitor and
  • Time the right time for delivery
    • ggf. consider corticosteroids to help development of fetus
20
Q

Which factors are monitored in pre-eclapsia and considered to time the right time for delivery?

A

Doppler assessment of Arteries

  • uterine artery
  • umbilical artery
  • fetal middle cerebral artery
  • ductus venosum
    • Are also indicators of metabolic status

Fetal movements (reduction might precede fetal death)

  • done by Cardiff Kick chart and/or
  • CTG
21
Q

Explain the sequence of events in IUGR that might lead to Fetal Death

A
22
Q

Explain the effects of Hypoxia in the fetus

A
23
Q

What is the Ductus Venosus?

How might it be used in prediction of IUGR?

A

Longitudinal through upper abdomen
• Parallel, anterior to the right of the aorta • Receives 40% of umbilical venous flow
• Directs oxygenated blood to the L ventricle

  • Change its Doppler screening in Hypoxia/Acidosis
24
Q

Compare early vs late IUGR

A

Year 2 LCRS RDA (11 decks)

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