Fetal growth

Question 1

What is SFD

Answer 1

Small for date

Measurement below 10th population centile for gestational age

Question 2

What is LFD

Answer 2

Large for date

Measurement above 95th population centile for gestational age

Question 3

What is gestational age centile chart affected by

Answer 3

Maternal BMI and ethnicity

Question 4

How can fetal growth be measured

Answer 4

Symphysis fundal height (30-40% sensitive)
USS (90-95% sensitive):
Abdominal circumference
Femur length
Head circumference

Question 5

Definition of fetal growth restriction

Answer 5

Fetus failed to reach genetic growth potential

<5th centile for gestational age (5-10th can be normal variation e.g small mother)

Question 6

Risk factors for fetal growth restriction (12)

Answer 6

Smoking
Alcohol
Substance use
1st trimester bleeding 
Domestic violence
Previous FGR
Recurrent fetal loss
Raised AFP
Placenta insufficiency
Hypertension
Infection
Renal disease

Question 7

Reasons for SFD

Answer 7

Normal variation (healthy baby)
Placental insufficiency
Infection (CMV common)
Chromosomal abnormality 
Incorrect date/measurement - dating scans 4 weeks apart to confirm gestational age and correct measurements

Question 8

How to assess placental function

Answer 8

Uterine artery Doppler

Resistance to flow shows diastolic notching or reverse diastolic flow (more severe)

Question 9

Normal small vs FGR

Answer 9

Healthy baby symmetrical
Liquor volume normal in healthy, can be increased in chromosomal effect/infection, can be reduced in placental insufficiency
Uterine artery Doppler shows resistance to flow in placental insufficiency

Question 10

Which Doppler scans can be used for surveillance of FGR

Answer 10

Umbilical artery - shows increases in placental resistance to flow
Middle cerebral artery - increased flow shows placental resistance to flow
Ductus venosus - predicts need for delivery

Question 11

Monitoring for GFR

Answer 11

Maternal monitoring: regular BP and urine dipstick checks

Fetal monitoring: fetal movements, Doppler, amniotic volume measurements, biophysical profile

Question 12

When should you deliver a FGR with abnormal UMA Doppler

Answer 12

<37 weeks

Question 13

When should you deliver a FGR with AREDF

Answer 13

> 34 weeks

Question 14

Under what circumstances should you deliver a FGR with AREDF before 34 weeks

Answer 14

Abnormal CTG
Abnormal Doppler
Abnormal biophysical profile

Question 15

When should the Doppler scans be done

Answer 15

Assess risks for IUGR at booking visit and then if necessary organise:
Uterine artery - 20-22 weeks
Umbilical artery - 1st line if FGR suspected at 26-28 weeks
MCA and DV - if UMA abnormal

Question 16

Causes of increased symphysis fundal height

Answer 16

Macrosomic baby 
Fibroids
Pelvic mass
Polyhydramnios
Maternal obesity

Question 17

Causes of a macrosomic baby

Answer 17

Gestational diabetes
Maternal obesity
Increased maternal age
Multiparity 
Constitutionally large baby
Male fetus
Postmaturity baby

Question 18

Risks of macrosomic baby

Answer 18

Prolonged labour/ postpartum haemorrhage 
Genital tract trauma 
Perinatal asphyxia
Shoulder dystocia
Neonate hypoglycaemia 
Metabolic syndrome

Question 19

How to test for gestational diabetes

Answer 19

Oral glucose tolerance test

HbA1c >30 weeks

Question 20

When should Caesarian section be offered for diabetes and macrosomia

Answer 20

Diet controlled <40 weeks
Metformin controlled at 39 weeks
Insulin controlled at 38 weeks
Due to increased stillbirth risk

Any macrosomia at 38 weeks

Question 21

What week gestation is uterus fundus felt at pubic symphysis

Answer 21

12

Question 22

What week gestation is uterus fundus felt at umbilicus

Answer 22

22

Question 23

What week gestation is uterus fundus felt half way between umbilicus and xiphisternum

Answer 23

28

Question 24

What week gestation is uterus fundus felt at xiphisternum

Answer 24

36

Question 25

What is the 1st trimester

Answer 25

1-12

Question 26

What is the 2nd trimester

Answer 26

13-28

Question 27

What is the third trimester

Answer 27

29-40