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Obs & Gynae > Fetal Growth and Abnormal Lie > Flashcards

Fetal Growth and Abnormal Lie Flashcards

1
Q

What are causes of perinatal mortality?

A 
Preterm delivery
IUGR
Congenital abnormalities
Intra-partum (hypoxia)
Placental abruption
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2
Q

What is cerebral palsy associated with?

A 
Prematurity
IUGR
Infection
Pre-eclampsia
Congenital abnormalities
Intra-partum fetal distress
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3
Q

What is the definition of small for dates?

A

Weight of fetus is less than tenth centile

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4
Q

What is the definition of intrauterine growth restriction?

A

Failure to meet growth potential

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5
Q

What is the definition of fetal distress?

A

Acute situation which may result in fetal damage or death

Mainly used in labour

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6
Q

What is the definition of fetal compromise?

A

Chronic situation when conditions for normal growth and neurological development are not optimal
Poor nutrient transfer through placenta
IUGR

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7
Q

What are pre-pregnancy risk factors?

A

Mother’s age
Previous medical and obstetric history

Not a specific or sensitive screening test

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8
Q

What are the benefits and limitations of serial growth scans?

A

Safe and shows consistent growth in high-risk and multiple pregnancies

Inaccurate measurements common, misleading and potentially harmful

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9
Q

What are the benefits and limitations of Doppler umbilical artery waveforms

A

High resistance circulation (reduced flow in fetal diastole compared to systole) suggests placental dysfunction

Identifies which small fetuses are IUGR

Less effective identifying normal weight, compromised fetus

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10
Q

What are the benefits and limitations of Doppler waveforms of the fetal circulation?

A

Esp middle cerebral arteries (reduced resistance) and ductus venosus

Used in high risk pregnancy and with suspected anaemia

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11
Q

What are causes of IUGR?

A 
Pre-existing maternal disease
Maternal pregnancy complications
Multiple pregnancy
Smoking
Drug usage
Infection
Extreme malnutrition
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12
Q

What is a prolonged pregnancy?

A

More than 42 weeks are completed

More common in nulliparous women

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13
Q

What are risks of a prolonged pregnancy?

A

Stillbirth
Encephalopathy
Meconium passage

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14
Q

How is prolonged pregnancy managed?

A

Induce labour between 41 to 42 weeks

Sweep cervix

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15
Q

What are causes of an abnormal lie?

A

Polyhydramnios
High parity
Fetal/uterine abnormalities
Twin pregnancies

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16
Q

What are complications of an unstable lie?

A

Umbilical cord may prolapse when membranes rupture

May cause uterine rupture

17
Q

How are unstable or transverse lie managed?

A

After 37 weeks, admit to hospital in case membranes rupture

USS to exclude known causes - polyhydramnios, placenta praevia

ECV unjustified as it turns back

18
Q

What are types of breech presentation?

A

Extended - 70% both legs extended at knee

Flexed breech - 15% both legs flexed at knee

Footling breech - 15% one or both feet are below the buttocks

19
Q

What are complications of a breech presentation?

A

Cord prolapse

Head may get trapped

20
Q

What is ECV?

A

Done from 37 weeks
Success rate of 50%
3% will turn back

Done without anaesthetic but tocolytic given to relax uterus

CTG done afterwards with anti-D if needed

21
Q

What are contraindications to ECV?

A 
Compromised fetus
If vaginal delivery would be contraindicated
Twins
ROM
Recent APH
22
Q

How common are twins and triplets?

A

1 in 80 are twins

1 in 1000 are triplets

23
Q

What are dizygotic twins?

A

Fertilisation of different ooxytes by different sperm

May be different sex and as genetically similar as siblings

24
Q

What are monozygotic twins?

A

Mitotic division of single zygote into identical twins

Whether they share the same amnion and placenta depends on when in division they split

25
Q

What are the different types of monozygotic twins?

A

Division before day 3 (30%) - separate placentas and amnions (dichorionic diamniotic DCDA)

Division between days 4 and 8 (70%) - shared placenta but separate amnions (monochorionic diamnioric MCDA)

Later division very rare and causes twins with shared placenta and amnion (monochorionic monoamniotic MCMA)

26
Q

How are multiple pregnancies diagnosed?

A

Vomiting

Larger uterus than expected for dates

27
Q

What are maternal complications of multiple pregnancy?

A

Gestational diabetes
Pre-eclampsia
Anaemia - greater increase in blood volume

28
Q

What are fetal complications of multiple pregnancies?

A 
Greater mortality and long term handicap
Preterm delivery
IUGR
TTTS
Miscarriage - one twin can vanish with a first trimester death
29
Q

What are complications of monochorionicity?

A

Twin-twin transfusion syndrome
IUGR
Co-twin death - if one twin dies, the drop in BP allows acute transfusion of blood from the alive twin -> hypovolaemia -> death or neuro damage
Monoamniotic twins - cords are tangled -> death

30
Q

What is twin-twin transfusion syndrome?

A

Only occurs in MCDA twins
Unequal blood distribution through anastamoses of shared placenta

Donor twin is volume depleted and becomes anaemic, IUGR and oligohydramnios

Recipient twin is volume overloaded and develops polycythaemia, cardiac failure and polyhydramnios

31
Q

What are intrapartum complications of twins?

A

Malpresention of first twin (20%) - indication for c-section

Fetal distress - second twin may die of hypoxia, cord prolapse, tetanic uterine contraction or placental abruption

PPH

32
Q

How are multiple pregnancies managed antepartum?

A

Consultant led care
Iron and folic acid supplements
Normal screen for abnormalities

At 12 weeks, selective reduction offered to triplets

TV ultrasound to identify short cervix = risk of preterm

Serial USS at 28, 32 and 36 weeks to identify IUGR

33
Q

What extra antepartum management is done for monochorionic twins?

A

USS from 12 weeks - watch out for TTTS (tricuspid regurg and polyhydramnios)

Laser photocoagulation of placental anastomoses in fetal medicine centre

34
Q

How are fetal abnormalities managed in twins?

A

Before 14 weeks - KCl, or can be done after 32 weeks so if delivery happens, remaining twin will survive

In MCDA twins, cord must be occluded using bipolar diathermy as circulation is shared

35
Q

How are twins delivered?

A

C-section - esp if first fetus is breech or transverse lie
34-38 weeks
CTG
Epidural helpful

Contractions diminish after first twin, usually return quickly - check lie of baby and do ECV if needed
Normally deliver 2nd twin within 20 mins

Can have vaginal delivery if first twin is cephalic

Obs & Gynae (20 decks)

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