6: Problems in pregnancy - small for dates

Question 1

For what three reasons may a baby be born small?

Answer 1

Pre-term delivery

Intrauterine growth restriction

Constitutionally small

Question 2

The earlier in gestation a woman gives birth, the ___ ___ their baby is to survive.

Answer 2

earlier = less likely to survive

Question 3

Which growth centile must a foetus be under to be called small for gestational age?

Answer 3

10th centile

Question 4

Which measurement can be taken on examination to track foetal growth?

Answer 4

Fundus-symphysial height

Question 5

What measurements can be taken on foetal ultrasound to track foetal growth?

Answer 5

Abdominal circumference

Femur length

Question 6

If a baby is small for gestational age, by which point should it ideally be delivered?

Answer 6

37 weeks

Question 7

Pre-term delivery is also known as ___.

Answer 7

prematurity

Question 8

Pre-term delivery is the birth of a child before which point in gestation?

Answer 8

Week 37

Question 9

What can trigger pre-term delivery?

Answer 9

Illness e.g infection

Over-distension e.g multiple pregnancy, polyhydramnios

Vascular disease - placental abruption

Trauma

Question 10

What measurements can be taken to estimate the growth of a foetus?

Answer 10

Fundal height

Estimated foetal weight

On USS: abdominal circumference, femur length

Question 11

What is the definition of a low birth weight?

Answer 11

< 2.5kg at any point in gestation

Question 12

Intrauterine growth restriction can be ___ or ___.

Answer 12

symmetrical or asymmetrical

symmetrical - genetic disorders

asymmetrical - placental problems

Question 13

Which imaging is used to measure foetal growth during pregnancy?

Answer 13

Ultrasound

Question 14

Which foetal ultrasound measurements are used to estimate foetal weight?

Answer 14

Abdominal circumference

+/- Femur length

Question 15

Which specific ultrasound scans are used if poor foetal growth is suspected?

Answer 15

Uterine artery doppler

MCA scan

Question 16

What underlying disease causes placental infarction and abruption?

Answer 16

Maternal hypertension

Question 17

What are some maternal reasons for intra-uterine growth restriction?

Answer 17

Lifestyle factors - smoking, alcohol, drug use

Co-morbidities e.g hypertension

Extremes of age

Question 18

What are some foetal reasons for intra-uterine growth restriction?

Answer 18

Infection e.g toxoplasmosis, CMV

Congenital abnormalities

Genetic disorders e.g trisomy 21

Question 19

What are some placental reasons for intra-uterine growth restriction?

Answer 19

All related to hypertension - infarction, abruption, insufficiency

Question 20

What are the findings of poor foetal growth on examination?

Answer 20

Reduced fundal height

Reduced liquour

Reduced foetal movements

Question 21

What are some types of doppler ultrasound scan used in the assessment of foetal wellbeing?

Answer 21

Uterine artery doppler

Umbilical artery doppler

MCA scan

Question 22

If a baby is small for dates, when should it be delivered?

Answer 22

Week 37

Question 23

Which drugs can be used to help deliver small-for-dates babies?

Answer 23

Steroids - speeds up production of pulmonary surfactant

Magnesium sulphate - for neuroprotection

Question 24

What is the purpose of steroids in premature delivery?

Answer 24

Increases lung development (production of pulmonary surfactant)

Question 25

What is the purpose of magnesium sulphate in premature delivery?

Answer 25

Neuroprotection

Question 26

If a small-for-dates pregnancy is showing signs of static growth or their scans are dodgy, what is indicated?

Answer 26

Caesarean delivery

no matter the gestation