Fetal Growth And Nutritiom Flashcards
Stage one embryo growth
Hyperplasia 4-20 weeks
Rapid mitosis and increase DNA content
Stage 2 embryo growth
Hyperplasia and hypertrophy 20-28 weeks
Declining mitosis with increased cell size
Stage 3 embryo growth
Hypertrophy 28-40
Increase in cell size (peak velocity 33 weeeks)
Rapid accumulation of fat muscle and connective tissue
Most fetal weight gained when?
95% in second half
When do we check for growth
12th week (first trimester)
Ultrasound
12 weeks scan is a Routine scan that checks for
Viability single fetus/multiple
Measure crown rump length (top of head to borrow of buttocks)
Routine second trimester scan is
Routine anomaly scan
18-20 weeks
Assess- fetal growth
Fetal anomalies
Placental site
For low risk women what is their
Last scan
Anomaly scan
Low risk women then have what measured (after anomaly )
Fundus to symphysis height
Fundus (variable)
Symphysis (fixed)
Anminiotic fluid is measured to obtain
Amniotic fluid index
Fetal Doppler measures what
Blood flow through umbilical and middle cerebral artery
I’d measurement is high then blood has to work harder to get through
How to analyse fetal growth curves
On trend -appropriate for gestational age
Small for age-on trend but a slightly lower slope
Fetal growth restriction - on trend then platues
Fetal growth restriction occurs due to
Insufficient nutrient
Delivery gas exchange
Vascular disease
02 capacity low
Small for gestational age (sga)
Infant: birth weight < 10th centile
Fetus: EFW OR AC < 10th centile
FGR may result in
Increased morbidity and morality
Still birth
Seizures
Apgar score
Cord ph < 7
Admission to intensive care
Hypothermia
Hypoglycaemia
Low PAPP-A
Bad placentation
LOW PAPPA risk of and treated with
Increase risk of SGA /preeclampsia
Give 75mg aspirin
Arrange growth scenes 26-28 weeks and 34-36 weeks
Maternal artery measurement (uterine artery Doppler) can be done when
1sr trimester or 20-24 weeks
If abnormal growth shown on scans then
Increase scans
If FGR /functional concerns then
Consider early delivery (steroids)
If SGA
Consider induction at 37 weeks
Macrosomia
Birth weight over 4kg
What increases chances of large baby
Large or tall parents
How BMI affects risk of large baby
BMI 25-30 =1.5X risk
BMI 30+= X2 risk
Large baby defined as
One that has been on the trend then jumps over 90th centile randomly
Screen for diabetes in preg if
BMI<30
Previous macrosomic baby
Previous gestational diabetes
Family history of diabetes
Offer caesarean if
EFW>4.5 kg in diabetic
EFW >5 kg in non diabetic
Big baby causes what problems
Shoulder dyslocia (shoulder gets stuck on exit) Causing
Brachial plexus damage
Fractured humerous
Birth asphyxia
