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fetal growth disorders Flashcards

1
Q

which measurements are used for the estimation of fetal weight ?

A 
BPD biparietal diameter 
HC head circumference 
AC abdominal circumference 
FL femur length 
all by ultrasound
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2
Q

what is fetal growth rate affected by ?

A

placental function

genetic or constitutional factors

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3
Q

what factors affect fetal birth weight ?

A 
function of both gestational age 
rate of fetal growth
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4
Q

what does appropriate for gestational weight mean ?

A

infants born with a birth weight between 10th and 90th centile for their gestational age

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5
Q

what does small for gestational age mean ?

A

infants born with a birth weight less than 10th centile for their gestational age

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6
Q

what does large for gestational age mean ?

A

infants born with a birth weight more than 90th centile for their gestational age

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7
Q

what does fetal growth restriction mean ?

A

implies a pathological restriction of the genetic growth potential and they may show signs of fetal compromise

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8
Q

what does low birth weight mean ?

A

infants with a birth weight less than 2500 g regardless of their gestational age

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9
Q

when do we consider a baby to be born pre-term?

A

24 to 36 weeks

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10
Q

when do we consider a baby to born early term ?

A

37-38 weeks

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11
Q

when do we consider a baby to be born full term ?

A

39-40 weeks

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12
Q

when do we consider a baby to be born late term ?

A

41 weeks

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13
Q

when do we consider a baby to be born post term ?

A

at 42 weeks

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14
Q

what can we divide babies that are born small for gestational age into ?

A

normal/constitutional
non placenta mediated growth restriction
placenta mediated growth restriction

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15
Q

how do we screen for SGA ?

A 
history 
biochemical markers (PAPP-A)
uterine artery doppler at 20-24 weeks gestation
 ( anomaly scan)
clinical examination
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16
Q

how do we make a diagnosis of SGA ?

A

ultrasound biometry
doppler
amniotic fluid index

17
Q

what is the brain sparing syndrome ?

A

in cases of chronic placental insufficiency the fetus reacts to the restricted placental perfusion by redirecting the blood back to the brain

18
Q

what are the results of the brain sparing syndrome ?

A
  1. an increased ( head circumference/ abdominal circumference ratio )
  2. reduced renal perfusion and decreased urine output which causes oligohydraminous
19
Q

what can be done to prevent SGA ?

A
  1. anti-platelete agents may be effective

2. cessation of smoking

20
Q

when should anti-platelete agents be commenced ?

A

should be commenced at or before 16 weeks of pregnancy

21
Q

what is the primary surveillance tool in the SGA ?

A

umbilical artery doppler

22
Q

what other blood vessels are important to asses using doppler ?

A

middle cerebral artery

ductus venous

23
Q

other than doppler what can be used for fetal surveillance in SGA ?

A

CTG
US assessment of amniotic fluid volume
biophysical profile

24
Q

what are the aspects of the biophysical profile ?

A
  1. breathing movement
  2. gross body movement
  3. tone
  4. amniotic fluid volume
25
Q

what is the management in SGA ?

A

if planning to deliver between week 24 and week 35 weeks :
give antenatal corticosteroids
offer Magnesium Sulphate

26
Q

what is the management if the baby with SGA has a normal umbilical artery doppler ?

A

delivery should be offered at 37 weeks with doppler follow up every 14 days

27
Q

what is the management if the baby with SGA has an abnormal umbilical arttery doppler ?

A

this depends on if the end diastolic velocities are preserved :

  1. if they are —> deliver no later than 37 weeks with doppler follow up twice weekly
  2. not preserved —> delivery should be considered between 30-32 weeks with daily follow up with doppler
28
Q

how should an SGA baby be delivered ?

A

if the end diastolic velocities are perserved then normal labour can be offered
for no perserved end diastolic velocity caesarian section should be offered

29
Q

when can we call a fetus macrosomic?

A

when the fetus is born exceeding 4000 gm regardless of its gestational age

30
Q

what are the risk factors for having a macrosomic baby ?

A 
maternal diabetes 
maternal obesity 
post-term pregnancy 
grand multipara 
previous LGA baby
31
Q

what are the fetal complications of macrosomia ?

A

IUFD
birth trauma
hypoglycemia

32
Q

what are the maternal complications of macrosomia ?

A

higher chance of CS delivery
trauma to the birth canal
postpartum hge

33
Q

when do we plan for an elective CS in macrosomic babies ?

A

5 kg baby in non diabetic women

4.5kg in diabetic women

WH (68 decks)

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