Antepartum Haemorrhage Flashcards

Question

Minor risk factors for SGA

Answer 1

``` o Maternal age ≥35 years. o IVF singleton pregnancy. o Nulliparity. o BMI <20. o BMI 25-34.9. o Smoker - 1-10 cigarettes per day. o Low fruit intake pre-pregnancy. o Pregnancy interval <6 months. o Pregnancy interval ≥60 months. ```

Answer 2

``` o Maternal age >40 years. o Smoker - ≥11 cigarettes per day. o Paternal or maternal SGA. o Cocaine use. o Daily vigorous exercise. o Previous SGA baby. o Previous stillbirth. o Chronic hypertension. o Diabetes with vascular disease. o Renal impairment. o Antiphospholipid syndrome. o Heavy bleeding similar to menses. o Pregnancy associated plasm protein-A (PAPP-A) <0.4 multiples of the median (MOM). ```

Answer 3

* Serial measurement of symphysis fundal height (SFH) is recommended at each antenatal appointment from 24 weeks of pregnancy as this improves prediction of an SGA neonate. * Women with a single SFH which plots below the 10th centile or with serial measurements which demonstrate slow or static growth by crossing centiles should be referred for ultrasound measurement of fetal size. * Women in whom measurement of SFH is inaccurate (for example, BMI >35, large fibroids, hydramnios) should be referred for serial assessment of fetal size, using ultrasound.

Answer 4

* The most effective interventions to prevent the SGA fetus were antiplatelet agents like aspirin before 16 weeks in women at risk of pre-eclampsia, and progesterone therapy for prevention of preterm birth. * For the prevention of perinatal mortality in high-risk women, antiplatelets and antenatal corticosteroids were found to be effective interventions

Answer 5

o Women who have a major risk factor should be referred for serial ultrasound measurement of fetal size and for assessment of well-being with umbilical artery Doppler from 26-28 weeks of pregnancy. o Women who have three or more minor risk factors should be referred for uterine artery Doppler at 20-24 weeks of gestation. o Karyotyping should be offered in severely SGA foetuses with structural anomalies and in those detected before 23 weeks of gestation. o Women with an SGA foetus between 24+0 and 35+6 weeks of gestation, where delivery is being considered, should receive a single course of antenatal corticosteroids.

Answer 6

o In the preterm SGA foetus with umbilical artery absent or reversed end-diastolic velocity (AREDV) detected prior to 32 weeks of gestation, delivery is recommended when DV Doppler becomes abnormal or umbilical vein pulsations appear, provided the foetus is considered viable and after completion of steroids. Even when venous Doppler is normal, delivery is recommended by 32 weeks of gestation and should be considered between 30-32 weeks of gestation. o If MCA Doppler is abnormal, delivery should be recommended no later than 37 weeks of gestation. o In the SGA foetus detected after 32 weeks of gestation with an abnormal umbilical artery Doppler, delivery no later than 37 weeks of gestation is recommended. o Delivery by C section is recommended.

Answer 7

• This is a condition where a baby’s growth slows or ceases when it is in the uterus.

Answer 8

* IUGR is the common result of maternal, placental, fetal or genetic factors. * Any mismatch between the supply of nutrient by the placenta and the demand of the foetus also leads to IUGR.

Answer 9

o Maternal age (less than 16 years or more than 35 years) o Low socio-economic status o Parity (none or more than five births) o Inter-pregnancy interval less than 6 months or an interval of 120 months or more). o Previous delivery of an SGA newborn. o Maternal substance abuse o Maternal medication o Maternal pre-pregnancy BMI less than 20, weight less than 45 kg or more than 75 kg. o Assisted reproductive technologies. o Pregnancy: moderate to heavy physical work, severe maternal starvation, poor weight gain, high-altitude and maternal hypoxia, poor medical care. o Maternal medical disorders o Maternal infection and parasite infestations

Answer 10

Smoking Alcohol Marijuana Cocaine

Answer 11

``` Asthma Cyanotic congenital heart disease Hypertensive disorders Pre-eclampsia Diabetes associated with vasculopathy CKD SLE Antiphospholipid syndrome Sickle cell disease Acquired thrombophilia ```

Answer 12

``` Warfarin Antiepileptics Antineoplastics Folic acid antagonists Steroids Antimetabolite ```

Answer 13

TORCH syndrome (= toxoplasmosis, other, rubella, cytomegalovirus, herpes simplex), malaria, tuberculosis, urinary tract infections and bacterial vaginosis).

Answer 14

o Chromosomal abnormalities – e.g., trisomies 13, 18, or 21, autosomal deletions, triploidy, ring chromosomes and uniparental disomy. o Genetic syndromes – e.g., Russell-Silver syndrome, Rubinstein-Taybi syndrome, Dubowitz's syndrome, Seckel's syndrome, Fanconi's syndrome. o Major congenital anomalies – e.g., tracheo-oesophageal fistula, congenital heart disease, congenital diaphragmatic hernia, abdominal wall defects (omphalocele or gastroschisis), neural tube defect (eg, anencephaly), anorectal malformation. o Multiple gestation. o Congenital infections (TORCH syndrome, malaria, congenital HIV infection, syphilis). o Metabolic disorders – e.g., congenital lipodystrophy, galactosaemia, generalised gangliosidosis type I, hypophosphatasia, fetal phenylketonuria.

Answer 15

Placental factors – e.g., placental dysfunction (including pre-eclampsia), placental abruption.

Answer 16

• There are predominately three types of IUGR: o Asymmetrical IUGR (malnourished babies- occurs later in pregnancy) o Symmetrical IUGR (hypoplastic SGA)- occurs early in pregnancy o Mixed IUGR- early IUGR complicated by placental dysfucntion

Answer 17

* GROW chart | * Umbilical artery doppler scan- reduces perinatal morbidity and mortality in a high-risk population.

Answer 18

``` o Perinatal asphyxia o Meconium aspiration o Persistent pulmonary HTN o Hypothermia o Hypoglycaemia o Hyperglycaemia o Hypocalcaemia o Polycythaemia o Jaundice o Feeding difficulties o Feed intolerance ```

Answer 19

o Lower scores on cognitive testing o Cerebral palsy o Behavioural problems: hyperactive behaviour, ADHD o Poor perceptual performance o Susceptible to diabetes, HTN, obesity, metabolic syndrome, CHD.

Answer 20

o Antiplatelet agents may be effective in preventing SGA in women at high risk of pre-eclampsia, although the effect size is small. o In women at high risk of pre-eclampsia, antiplatelet agents should be commenced at, or before, 16 weeks of pregnancy. o There is no consistent evidence that dietary modification, progesterone or calcium prevents SGA. o Interventions to promote smoking cessation may prevent SGA and should be offered to all pregnant women who smoke.

Answer 21

• Signs include loss of tendon reflexes, respiratory depression and cardiac arrest.