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Obstetrics > Antenatal: SGA, LGA, Abnormal Lie, Multiple Pregnancy > Flashcards

Antenatal: SGA, LGA, Abnormal Lie, Multiple Pregnancy Flashcards

1
Q

Define small for gestational age

A

Weight or abdominal circumference below the 10th centile for age

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2
Q

How will placental factors present on growth chart

A

Asymmetric growth.

Head circumference is preserved, but abdominal circumference is reduced

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3
Q

Why does asymmetrical growth occur

A

As foetus tries to preserve nutrients

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4
Q

What are placental causes of SGA

A

Placental insufficiency:

  • Abruption
  • Pre-eclampsia
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5
Q

How will foetal factors of SGA present on growth chart

A

Symmetrical growth restriction

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6
Q

What are the 3 categories of foetal factors of SGA

A

Congenital Anomalies
Infection
Multiple pregnancy

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7
Q

What genetic anomalies may cause SGA

A

Down syndrome
Edward’s
Patau’s

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8
Q

What congenital infection anomalies may cause SGA

A

Rubella

CMV

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9
Q

Give 10 major risk factors of SGA

A 
>40 
Smoking 
Cocaine-use 
Chronic HTN
Antiphospholipid 
Renal insufficiency 
Diabetes 
Low PAPP-A
Ecogenic bowel 
APH 
Pre-eclampsia 
Previous SGA 
Previous still-birth 
Mother/Father SGA
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10
Q

Give 5 minor factors for SGA

A 
>35
BMI<20
Nulliparous 
IVF
PIH
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11
Q

Explain assessment for SGA

A

Women is assessed at booking for risk of SGA. All women are given a personalised growth chart based on BMI, Age, Ethnicity, Previous parity and Birth weight of previous children

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12
Q

When should any women be referred for US scan

A

If SFH <10th centile

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13
Q

Explain management of women considered at risk of SGA at booking

A

Serial growth scans every 2-3W

US doppler at 28W

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14
Q

If a women has 3 or more risk factors for SGA what is she offered

A

US doppler at 24-26W

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15
Q

If the umbilical artery is normal on US what is done

A

Aim for IOL at 37W

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16
Q

If umbilical artery is abnormal on US what is done

A

Aim for pre-term delivery

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17
Q

Up to what time frame will women need corticosteroids

A

Up to 35+6

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18
Q

If umbilical artery is absent or shows reversed end-diastolic flow on doppler what is done

A

Urgent LSCS

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19
Q

What are immediate risks to foetus with SGA

A

Cerebral palsy
Neonatal morality
Still-Birth

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20
Q

What are SGA children at increased risk of in adult life

A

T2DM
Thyroid disease
HTN
CAD

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21
Q

Define large for gestational age

A

Baby above 95th centile for weight

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22
Q

What are 3 risk factors for large-gestational age

A

FH
Obese mother
Diabetes

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23
Q

What are complications of LGA

A 
Shoulder dystocia 
Hypoglycaemia 
Hypocalcaemia 
Polycythaemia - leading to jaundice 
Left colon syndrome
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24
Q

What is left colon syndrome

A

Self-limiting condition that mimics Hirschsprung’s by cause temporary bowel obstruction

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25
Q

Define breech

A

caudal end of foetus is in lower uterine segment

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26
Q

What are 4 uterus risk factors for breech delivery

A

Fibroids
Uterine anomalises (septal uterus)
Multiparous
Placenta praevia

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27
Q

What are 5 foetal risk factors for breech delivery

A

Polydryamnios
Multiple pregnancy
Pre-mature
Congenital anomaly

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28
Q

What are the 3 types of breech delivery

A

Complete
Frank
Footling

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29
Q

What is a complete breech

A

Hip and knee flexed

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30
Q

What is a frank breech

A

Hip flexed, knee extended

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31
Q

What is a footling breech

A

One or both feet extended at the hip

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32
Q

What % of babies are breech at 28W

A

20

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33
Q

What % of babies are breech at delivery

A

3

34
Q

When should diagnosis or breech therefore only be made

A

32-35W

35
Q

What is first-line management for breech baby

A

External cephalic version

36
Q

When can ECV only be offered

A

> 36W

37
Q

What is a contraindication to ECV

A

Ruptured membranes

38
Q

If ECV is unsuccessful or decline, what is recommended

A

C-Section

39
Q

what is an absolute contraindication to vaginal delivery in breech babies

A

Footling breech

40
Q

What is the main risk of breech delivery

A

Cord prolapse

41
Q

What does a breech delivery increase risk of

A

peri-natal morality

42
Q

How does breech delivery increase risk of perinatal morality

A

birth asphyxia

intracranial haemorrhage = due to head compression

43
Q

What is the foetal lie

A

Position of foetus relative to long axis of the mother

44
Q

What are the 3 types of foetal lie

A

Transverse
Longitudinal
Oblique

45
Q

What is foetal presentation

A

Part of the foetus in lower uterine segment

46
Q

What is foetal position

A

Position of foetuses head as it exits birth canal

47
Q

What is a brow presentation

A

When foetus has its head extended show chin is untucked

48
Q

How should brown presentation be managed

A

C-Section

49
Q

What position are babies usually in labour

A

Occipito-anterior

50
Q

What is a risk factor for multiple pregnancy

A

Previous multiple pregnancy
FH
Assisted reproduction

51
Q

What are the two types of multiple pregnancy

A

Dizygotic

Monzogotic

52
Q

What is type is the majority of twins

A

Dizygotic (80%)

53
Q

What are dizygotic twins

A

Two separate ova are fertilised by two seperate sperm and implant

54
Q

How will placenta and amniotic membrane present in dizygotic twins

A

Dichorionic (two placentas)

Diamniotic (two amniotic membranes)

55
Q

Can dizygotic twins be different sexes

A

Yes

56
Q

What do risk-factors for multiple pregnancy mainly increase the risk of

A

Dizygotic twins

57
Q

What % of twins are monozygotic

A

20%

58
Q

What are monozygotic twins

A

One ova is fertilised by a single sperm and then splits - meaning have identical genetic material

59
Q

Can monozygotic twins be different genders

A

No - same genetic material

60
Q

What does whether monozygotic twins share a placenta and amniotic sac depend on

A

At which stage ova divides

61
Q

If ova separates less than 3-days how does it present

A

Dichorionic

Diamniotic

62
Q

If ova separates 4-7d how will amniotic membrane and placenta present

A

Diamniotic

Monochorionic

63
Q

What % of twins are monochorionic, diamniotic

A

70%

64
Q

What 8-12d how will it present

A

Monochorionic

Monoamniotic

65
Q

If a ova splits >12d how will it present

A

Conjoined twins

66
Q

What are symptoms associated with multiple pregnancy

A
  • Uterus large for dates

- Hyperemesis gravidarum

67
Q

What do all multiple pregnancies count as

A

high-risk and therefore should be consultant led

68
Q

What is given to all multiple pregnancies at 12W

A

aspirin (75mg)

69
Q

What does a difference in growth of more than 25% indicate and how is this managed

A

twin-twin tranfusion syndrome

refer to tertiary care

70
Q

If dichorionic twins when is birth recommended

A

37W

71
Q

If monochorionic twins when is birth recommended

A

36W

72
Q

If triplets when is birth recommended

A

35W (Needs corticosteroids)

73
Q

What are 4 maternal risks of multiple pregnancy

A
  1. GDM
  2. Antepartum haemorrhage - increase risk of abruption and praevia
  3. Pre-eclampsia
  4. Polydhydramnios
74
Q

What are 3 foetal complications of multiple pregnancy

A
  1. IUGR
  2. Perinatal morality
  3. Twin-twin transfusion
75
Q

What are intrapartum complications of multiple pregnancy

A
  1. PPH
  2. Malpresentation
  3. Hypoxia of second-twin following delivery of first
  4. Cord prolapse
76
Q

What is twin-twin transfusion syndrome

A

Vascular anatamosis in placenta means one twin acts as a donor and other recipient

77
Q

How will donor twin present

A

Oligohydramnios
Anaemia
Growth restriction

78
Q

How will recipient twin present

A

Polyhydramnios
Foetal hydrops
Polycythaemia

79
Q

What is foetal hydros

A

Collection of fluid in two or more compartments

80
Q

How may twin-twin transfusion syndrome be managed

A

Amnioreduction, Monitor 2W US

Obstetrics (27 decks)

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