6: Problems in pregnancy - small for dates Flashcards
For what three reasons may a baby be born small?
Pre-term delivery
Intrauterine growth restriction
Constitutionally small
The earlier in gestation a woman gives birth, the ___ ___ their baby is to survive.
earlier = less likely to survive
Which growth centile must a foetus be under to be called small for gestational age?
10th centile
Which measurement can be taken on examination to track foetal growth?
Fundus-symphysial height
What measurements can be taken on foetal ultrasound to track foetal growth?
Abdominal circumference
Femur length
If a baby is small for gestational age, by which point should it ideally be delivered?
37 weeks
Pre-term delivery is also known as ___.
prematurity
Pre-term delivery is the birth of a child before which point in gestation?
Week 37
What can trigger pre-term delivery?
Illness e.g infection
Over-distension e.g multiple pregnancy, polyhydramnios
Vascular disease - placental abruption
Trauma
What measurements can be taken to estimate the growth of a foetus?
Fundal height
Estimated foetal weight
On USS: abdominal circumference, femur length
What is the definition of a low birth weight?
< 2.5kg at any point in gestation
Intrauterine growth restriction can be ___ or ___.
symmetrical or asymmetrical
symmetrical - genetic disorders
asymmetrical - placental problems
Which imaging is used to measure foetal growth during pregnancy?
Ultrasound
Which foetal ultrasound measurements are used to estimate foetal weight?
Abdominal circumference
+/- Femur length
Which specific ultrasound scans are used if poor foetal growth is suspected?
Uterine artery doppler
MCA scan
What underlying disease causes placental infarction and abruption?
Maternal hypertension
What are some maternal reasons for intra-uterine growth restriction?
Lifestyle factors - smoking, alcohol, drug use
Co-morbidities e.g hypertension
Extremes of age
What are some foetal reasons for intra-uterine growth restriction?
Infection e.g toxoplasmosis, CMV
Congenital abnormalities
Genetic disorders e.g trisomy 21
What are some placental reasons for intra-uterine growth restriction?
All related to hypertension - infarction, abruption, insufficiency
What are the findings of poor foetal growth on examination?
Reduced fundal height
Reduced liquour
Reduced foetal movements
What are some types of doppler ultrasound scan used in the assessment of foetal wellbeing?
Uterine artery doppler
Umbilical artery doppler
MCA scan
If a baby is small for dates, when should it be delivered?
Week 37
Which drugs can be used to help deliver small-for-dates babies?
Steroids - speeds up production of pulmonary surfactant
Magnesium sulphate - for neuroprotection
What is the purpose of steroids in premature delivery?
Increases lung development (production of pulmonary surfactant)
What is the purpose of magnesium sulphate in premature delivery?
Neuroprotection
If a small-for-dates pregnancy is showing signs of static growth or their scans are dodgy, what is indicated?
Caesarean delivery
no matter the gestation
