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Reproduction and Sexual Health > Baby Large/Small Gestational Age (L/SGA) > Flashcards

Baby Large/Small Gestational Age (L/SGA) Flashcards

1
Q

What weight and what gestational age make a baby ‘low birth weight (LBW)’?

A

LBW = >2.5kg regardless of gestation

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2
Q

What are risk factors for a small gestational age baby?

A 
History of pre-term birth
Multiple pregnancy
Drug use
Poverty
High parity
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3
Q

What is intrauterine growth restriction (IUGR)?

A

A failure for a baby to reach its growth potential

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4
Q

What is symmetrical IUGR and asymmetrical IUGR?

A

Symmetrical: small head and small body

Asymmetrical: small head and normal body

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5
Q

What complications can occur with IUGR?

A

Fetal hypoxia/death

Maldevelopment

Infection

Hypothernia

Polycythaemia

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6
Q

What are some maternal causes of IUGR?

A

Drug use
Chronic disease
Poor nutrition

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7
Q

What are some foetal causes of IUGR?

A

Infection (CMV, rubella, toxoplasma)

Chromosomal abnormality

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8
Q

What are some placental causes of IUGR?

A

Abruption (placenta seperates from uterine wall)

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9
Q

When should you aim to deliver a SGA baby?

A

37 weeks

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10
Q

What indicates a c-section for a SGA baby?

A

Static growth

Abnormal doppler testing

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11
Q

What should you give a baby which is going to born prematurely and why?

A

Steroids (matures lungs)

Magnesium sulphate (protects brain)

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12
Q

What makes a baby large for dates?

A

Fundal height > 2cm bigger than estimated for gestational age

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13
Q

What is macrosomia and why is it important to pick up?

A

Estimated foetal weight (EFW) > 90th centile

Risks gestational diabetes (do OGTT)

Risks dystocia (organise delivery plan)

Can cause post partum haemorrhage

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14
Q

What is polyhydramnios and why is it important to pick up?

A

Excess amniotic fluid

Can cause

  • cord prolapse
  • preterm labour
  • malpresentation
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15
Q

What are the maternal causes of polyhydramnios?

A

Diabetes

maternal hyperglycaemia causes foetal hyperglycaemia and poluria - polyuria produces excess fluid

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16
Q

What are the foetal causes of polyhydramnios?

A

Malformation

Monochorionic twins
(one amniotic sac for two foetuses requires more fluid)

Hydrops fetalis (foetal anaemia produces excess fluid for sufficient oxygen delivery)

Viral infection (CMV, toxoplasma, erythrovirus B19)

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17
Q

How does polyhydramnios present?

A

Abdominal discomfort
Tense shiny abdomen
Can’t feel foetal parts

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18
Q

How do you diagnose polyhydramnios?

A

Amniotic fluid index > 25cm
(US measurement of amniotic fluid)

Deepest pool > 8cm
(US measurement of deepest visible pocket of fluid)

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19
Q

How do you manage polyhydramnios?

A

OGTT, viral serology

Serial scans for monitoring

Deliver by 40 weeks

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20
Q

What are the risk factors for multiple pregnancy?

A

Assisted conception
Family history
Increased age/parity

21
Q

Define

  • zygosity
  • chorionicity
  • amniocity
A

Zygosity: how many eggs

  • monozygotic = one fertilised egg splits (identical twins)
  • dizygotic = two eggs fertilised by two sperm (non-identical)

Chorionicity: how many placentas

  • monochorionic = one placenta for both twins
  • dichorionic = two placentas, one for each twin

Amniocity: how many amniotic sacs

  • monoamniotic = one amniotic sac for both twins
  • diamniotic = two amniotic sacs, one for each twin
22
Q

Describe the following types of twin

  • Monochorionic monoamniotic (MCMA)
  • Monochorionic diamniotic (MCDA)
  • Dichorionic monoamniotic (DCMA)
  • Dichorionic diamniotic (DCDA)
A

MCMA: One placenta, one amniotic sacs

MCDA: One placenta, two amniotic sacs

DCMA: Two placentas, one amniotic sac

DCDA: Two placentas, two amniotic sacs

23
Q

What determines the form of monozygotic (identical) twins?

A

At what stage the fertilised egg splits

Day 0-3 (first half of week one)- DCDA

Day 4-7 (second half of week one) - MCDA

Day 8-14 (second week) - MCMA

Day >15 (after second week) - conjoined

24
Q

What determines the form of dizygotic twins?

A

Always DCDA

two seperate fertilisations so they develop their own placenta and amniotic sacs

25
Q

What form of twin is associated with poor outcomes, requiring more frequent observation?

A

Monochorionic

One placenta has to provide nutrients for two babies

26
Q

How does multiple pregnancy present?

A

Larger uterus

Hyperemesis gravidarum

High alpha fetoprotein

(exaggerated symptoms of normal pregnancy)

27
Q

Why is multiple pregnancy important to recognise?

A

Big risk to both foetuses

28
Q

How should you manage single foetal death in multiple pregnancy?

A

MRI other foetal brain 4 weeks after death of twin

risk of death/neurological abnormality in survivor

29
Q

What is twin-twin transfusion syndrome (TTTS) and how do you manage it?

A

One baby takes most of amniotic fluid (becomes polyhydramniotic) while the other gets less (becomes oligohydramniotic)

Fetoscopic laser ablation

30
Q

What form of twin is most likely to get cord entanglement?

A

MCMA

share everything, more likely to get tangled up

31
Q

How do you assess chorionicity?

A

USS

Lamba sign = DCDA

T sign = MCDA

32
Q

What medications should you give a mother with multiple pregnancy?

A

Iron/folic acid

Low dose aspirin

33
Q

How often should you US multiple pregnancy?

A

Monochorionic - fortnightly

Dichorionic - monthly

34
Q

When should you deliver multiple pregnancy?

A

Monochorionic - 36 weeks with steroids

Dichorionic - 37 weeks

35
Q

How do you manage preexisting DM in pregnancy?

A

Pre-pregnancy

  • HbA1c = 48
  • high dose (5mg ) folic acid

During pregnany

  • low dose aspirin
  • control BG
  • more regular retinopathy screening

Delivery
- aim for 38 weeks (earlier if complications)

36
Q

What is gestational diabetes?

A

Onset of glucose intolerance causing hyperglycaemia in pregnancy

37
Q

What causes gestational diabetes?

A

Human placental lactogen

(normally causes insulin resistance in pregnancy to ensure good glucose supply to baby - in at risk patient can cause diabetes)

38
Q

What are the complications of gestational diabetes?

A

Macrosomia

Maternal/baby diabetes later

39
Q

How do you diagnose gestational diabetes?

A

Oral glucose tolerance test (OGTT)

40
Q

When do you deliver in gestational diabetes?

A

Depends on hypoglycaemic agent

Diet controlled - 40 weeks
Metformin - 39 weeks
Insulin - 38 weeks

(method maternal preference but warn of shoulder dystocia risk)

41
Q

Women travelling from abroad presents with baby large gestational age.

Cause?

A

Late booker

risk factors: concealed pregnancy, vulnerable women, transfer of care

42
Q

Describe the basics of foetal growth assessment.

A

12 week dating scan (all women given growth chart)

Serial growth assessment from week 26

Concerning growth patterns may indicate growth scan/doppler assessment

43
Q

How do you measure growth at the growth assessments?

A

Fundal height - 1cm=1 week gestation

USS biometry if

  • this won’t work (e.g. fibroids, high BMI, multiple pregnancy)
  • high risk (diabetes)
44
Q

What are the indications for a growth scan?

A

(concerning growth patterns on serial growth assessment)

  • first fundal height measurement below 10th centile (above 90th not an indication)
  • dropping centiles
  • climbing centiles (above 90th)
  • static growth
45
Q

What do growth scans measure?

A

Estimated foetal weight (EFW)

46
Q

What do you do if the growth scan shows the baby is

  • small gestational age (SGA)
  • large gestational age (LGA)
A

SGA (EFW <10th centile)
- umbilical/middle cerebral artery doppler

LGA
- OGTT

47
Q

What do umbilical artery doppler and middle cerebral artery doppler assess?

A

Umbilical

  • growth
  • abnormal suggests grwoth restrition

Middle cerebral

  • cardiovascular
  • abnormal suggests foetal cardiovascular distress
48
Q

When should you deliver multiple pregnancy?

A

Dichorionic: week 37

Monochoiornic: week 36 (steroids)

Triplets: week 35 (steroids and c-section)

Reproduction and Sexual Health (5 decks)

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