Fetal Growth Problems

Question 1

Fetal development happens in?

Answer 1

First 12 weeks

Question 2

What is the small for gestational are foetus requirements?

Answer 2

Estimated fetal weight or abdominal circumference is less than 10th centile of fetal growth scan

Question 3

What do US scans measure for growth?

Answer 3

Abdominal circumference, head circumference, femur length liquor volume and Dopplers

Question 4

Causes of small babies?

Answer 4

1. Normal size- due to maternal size and ethnicity
2. Non placenta mediate growth restriction- chromosomal or structural problem, infection, errors of metabolism
3. Placenta mediated growth restriction- PET, hypertension, autoimmune disease, renal disease, diabetes.

Question 5

Symmetrical SGA happens in which groups and causes what?

Answer 5

1 and 2

Causing HC, AC, FL all reduced

Question 6

Asymmetrical IUGR in which group and what is reduced?

Answer 6

Group 3

AC reduced

Question 7

Risk factors for IUGR?

Answer 7

Maternal age over 40
Nulliparous
Low or high BMI
Diabetes, renal disease
Smoking
IVF
previous SGa infant
Maternal SGA
Hypertension/PET
PAPP-A less than 0.4MoM

Question 8

How to diagnose IUGR?

Answer 8

Smaller abdomen
Measure uterine size- symphysis-fundal height
Ultrasound

Question 9

Abdominal circumference reflects?

Answer 9

Size of fetal liver

Question 10

What is the cause of asymmetrical growth restriction?

Answer 10

Placental insufficiency- no excess glycogen deposited in the liver

Question 11

Ultrasound findings of IUGR?

Answer 11

Small AC ( small liver)

Decreased amniotic fluid ( this is produced by the kidneys), also called oligohydramnios

Increased blood flow to the brain (look at Middle Cerebral arteries in the brain – using the doppler effect scan

Question 12

Clinical features of IUGR?

Answer 12

SFH smaller than expected

Baby’s movements lessen to conserve energy

Fetal heart rate changes as hypoxia develops (as seen on CTG)

Fetal death

Question 13

How to monitor an FGR baby?

Answer 13

Ultrasound for Fetal growth, liquor volume, fetal doppler

Question 14

Timing of delivery depends on?

Answer 14

Gestational age
Doppler studies
Other risk factors

Question 15

What type of fetal dopplers are there?

Answer 15

Umbilical artery Doppler

Middle cerebral artery Doppler

Ductus venous Doppler

Question 16

Why are antenatal corticosteroids betamethasone/dexamethasone important?

Answer 16

Cross placenta and cause alveoli cells to produce surfactant gene

Surfactant stop collapse of alveoli cells by coating cells and reducing surface tension

Helps prevent neonatal distress syndrome

Question 17

When are antenatal corticosteroids given?

Answer 17

Before 34 weeks and 6 days

Question 18

What can you infuse 24 hours before delivery of preter/growth restricted delivery to reduce rates of cerebral palsy?

Answer 18

Magnesium sulphate

Recommended for foetuses less than 30 weeks