Abnormal fetal growth

Question 1

Define small for gestational age fetus

Answer 1

fetus that has failed to acheive a specific target size or estimated fetal weight by a specific gestational age

Question 2

what are the two types of small for gestational age fetus?

Answer 2

• constitutionally delayed

- fetal growth restriction

Question 3

low birth weight =

Answer 3

<2500 grams

Question 4

very low birth weight =

Answer 4

<1500 grams

Question 5

Maternal causes of SGA

Answer 5

Smoking
Infections, drug abuse
Hypertension, chronic illness

Question 6

Fetal causes of SGA

Answer 6

Multiple pregnancy
Fetal malformation
Fetal chromosomal abnormality

Question 7

Placental causes of SGA

Answer 7

placental insufficiency

Question 8

Diagnosis of SGA

Answer 8

-EXAM: abdominal palpation and symphyseal-fundal height
Ix: Ultrasound: abdominal circumference, biparietal diameter, femur length, head circumference
-serial measurements 2 weeks apart

Question 9

What causes asymmetric FGR?

Answer 9

Uteroplacental insuffiency - brain sparing effect

Question 10

What causes symmetric FGR?

Answer 10

Often from viral infection or chromosomal abnormalities

usually pathologic insult in early pregnancy

Question 11

Intrauterine complications of FGR?

Answer 11

• hypoxia

- intrauterine fetal demise

Question 12

Neonatal complications of FGR?

Answer 12

• hyperbilirubinema
• hypoglycemia
• meconium aspiration
• polycythemia
• temp dysregulation
• increase in perinatal mortality

Question 13

Infant complications of FGR?

Answer 13

• physically small

- delayed neurological development

Question 14

Adult complications of FGR?

Answer 14

-increased risk of cardiovascular disease and diabetes

Question 15

Management of FGR?

Answer 15

• Amniocentesis if indicated
• Survellance/fetal wellbeing (growth scans every 2 weeks, doppler, CTG)
• delivery based on doppler findings
• deliver in tertiary centre

Question 16

What gestational ages are antenatal steroids given for?

Answer 16

Between 24 0/7 and 36 6/7

Question 17

When is the optimal benefit of antenatal steroids?

Answer 17

Within 7 days

Question 18

Contraindications to steroids?

Answer 18

Any infection

NOTE: for diabetes they are given as inpatient with close monitoring

Question 19

Maternal risks of steroids?

Answer 19

• Poor sleep

- Elevated blood sugars requiring admission in diabetic mothers

Question 20

Macrosomia =

Answer 20

> 4500 grams

Question 21

Causes of macrosomia?

Answer 21

• Diabetes
• Post-term pregnancy
• Maternal obesity/excess weight gain
• Previous macrosomic infant
• Genetic predisposition

Question 22

What finding on ultrasound indicates macrosomia?

Answer 22

estimated fetal weight or abdominal circumference >90th percentile

Question 23

Risks associated with large for gestational age babies?

Answer 23

• C-section
• prolonged labour
• increased risk of vacum or forceps delivery
• shoulder dystocia