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Fetal Growth Restriction Flashcards

1
Q

Define fetal growth restriction

A

Failure of the fetus to achieve its predetermined growth potential

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2
Q

How is small gestational age defined?

A

Birth weight below 10th centile

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3
Q

What is associated with an increased risk of perinatal morbidity and mortality?

A

Low birth weight

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4
Q

Which three things are associated with similar pathologies?

A

Low birth weight
Fetal growth restriction
Preterm delivery

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5
Q

Describe the relationship between low birth weight neonates and growth restricted neonates

A

Not all low birth weight neonates are growth restricted

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6
Q

What are the most commonly employed centiles for small gestational age?

A

Tenth
Fifth
Third

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7
Q

Which centile is most SPECIFIC and what does this mean?

A

Third centile

Good at identifying people without the disease

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8
Q

Which centile is the most SENSITIVE and what does this mean?

A

Tenth centile

Good at correctly identifying babies with FGR

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9
Q

What is required for the diagnosis of fetal growth restriction?

A

Close observation over time

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10
Q

What is the consequence of IUGR for subsequent babies?

A

Increased risk of IUGR and IUD (intrauterine death) in subsequent pregnancies

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11
Q

What are the short term consequences of LBW/FGR/prematurity for the fetus?

A 
Respiratory distress (lack of surfactant)
Intravascular haemorrhage 
Sepsis
Hypoglycaemia 
Necrotising enterocolitis 
Jaundice 
Electrolyte imbalance
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12
Q

What are the medium term consequences of LBW/FGR/prematurity for the fetus?

A

Respiratory problems
Development delay
Special needs schooling

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13
Q

What are the long term consequences of LBW/FGR/prematurity for the fetus?

A

Fetal programming

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14
Q

List four causes of babies being ‘small for gestational age’

A

Dating problem (growth continues, dopplers and fluid are normal but we’ve got the date wrong)
May just be a normally small baby
Fetal abnormality/infection (5%)
Placental insufficiency (20%)

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15
Q

What are the consequences of an insufficient placenta?

A 
Reduced abdominal circumference
Reduced femur length
Reduced amniotic fluid
Baby pees less (conserves energy, moves less)
Deranged dopplers
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16
Q

Give some maternal medical factors related to blood which are associated with FGR and SGA

A

Chronic HTN
Pre-eclampsia
Anaemia
Thrombophilic defects

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17
Q

Give some maternal medical factors related to infection/inflammation/the immune system which are associated with FGR and SGA

A 
Malignancy
Severe chronic infection 
DM
Connective tissue diseases
Uterine abnormalities
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18
Q

Give some maternal behavioural factors associated with FGR and SGA

A 
Smoking
Alcohol
Drugs
Social deprivation
Poor nutrition
Age (<16 or >35)
Low weight (<50kg)
High altitude
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19
Q

Give some fetal factors associated with FGR and SGA

A 
Multiple pregnancies 
Structural abnormalities 
Chromosomal abnormalities 
IU infection
Inborn errors of metabolism
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20
Q

Give some placental factors associated with FGR and SGA

A 
Impaired trophoblast invasion 
Partial abruption or infarction
Chorioamnionitis 
Placental cysts
Placenta praevia
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21
Q

What is placenta praevia?

A

When the placenta actually blocks the neck of the uterus, meaning that the baby can’t get out

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22
Q

How long does placentation last for?

A

10-12 weeks

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23
Q

Give three key features of the placenta

A

Maintains immunological distance between mother and fetus
Acts as a transient hypothalamo-pituitary gonadal axis
Responsible for exchange of nutrients, gases and metabolic wastes

24
Q

As a special endocrine organ, name two things which the placenta produces

A

Protein peptides

Steroid hormones

25
Q

Compare the placental changes in pre-eclampsia and normotensive mothers

A

Normotensive:
Spiral arteries lose muscular strength -> widening of arteries -> increased blood flow

Pre-eclampsia:
Spiral arteries remain narrow, under high pressure -> reduced and insufficient blood flow to baby

26
Q

Define pre-eclampsia and state when it arises and resolves

A

De novo multisystem disease that manifests as hypertension and proteinuria
Starts: after 20th week
Resolves by 6th week post partum

27
Q

How common is HTN and pre-eclampsia in pregnancies?

A

10% of all pregnancies, but only 1-2% is severe form

28
Q

Give the measurements for proteinuria in pre-eclampsia

A

> 0.3g/24hr

Protein-creatinine ratio>30

29
Q

Give the classifications of pre-eclampsia

A

Mild (140-149/90-99mmHg) Moderate (150-159/100-109mmHg)

Severe (≥160/110mmHg)

30
Q

Generally speaking, which two reasons would require extra foetal growth monitoring?

A

Those where the mother has a history of obstetric problems

Concerns in the current pregnancy

31
Q

State for things which constitute a poor obstetric history and therefore require the new fetus to have extra growth monitoring

A

Previous stillbirth
Previous FGR
Placental abruption
Previous maternal HTN

32
Q

State four factors about the current pregnancy which may warrant extra fetal growth monitoring

A

Abnormal serum biochemistry
Reduced SFH
Maternal systemic disease
Antepartum haemorrhage

33
Q

Give an abnormal serum biochemistry and its indication

A

Low PAPP-A <0.03 MOM

PAPP-A = pregnancy associated plasma protein A

Note: PAPP-A is low in Down syndrome

34
Q

Give examples of systemic maternal disease

A

HTN
Coagulation
Renal problems

35
Q

What is antepartum haemorrhage?

A

Bleeding from into the genital tract before giving birth

36
Q

What can be used to assess uterine arteries?

A

Uterine artery doppler screen

37
Q

What are the two things which result from hypoxia to the fetus?

A

CNS dysfunction

Stimulation of chemoreceptors in aorta

38
Q

What are the consequences of CNS dysfunction following hypoxia to the fetus?

A

Poor tone
Altered breathing
Altered movement patterns
Changes in heart rate patterns

39
Q

What are the consequences of aortic chemoreceptor stimulation following hypoxia to the fetus?

A

Redistribution of cardiac output by:

increasing blood flow (to brain, heart and adrenals) and reducing blood flow (to lungs, kidneys and gut)

40
Q

Which areas of the fetus get increased blood flow following hypoxia?

A

Brain
Heart
Adrenals

41
Q

Which areas of the fetus get reduced blood flow following hypoxia?

A

Lungs
Kidneys (hence they pee less)
Gut

42
Q

What do you see in a doppler of the middle cerebral artery of the fetus during hypoxia?

A

Low resistance blood flow (more frequent triangles)

43
Q

Where does 25% of the blood flowing through the umbilical vein go to and affect?

A

Ductus venosus
Liver
Contributes to abdominal circumference growth

44
Q

Which part of the heart is dominant in foetuses?

A

Right ventricle

45
Q

Where does the blood go from the right side of the heart?

A

To the left side via foramen ovale

46
Q

What changes do you seen in venous doppler in FGR?

A

Baby more acidotic, therefore you see an abnormal venous doppler

47
Q

How can mothers help to monitor their fetal wellbeing?

A

By monitoring the time taken each day to feel TEN fetal kicks

48
Q

What do you do if the mother reports a reduction in or absence of fetal movements?

A

Do a cardiotocography (CTG) and/or ultrasound

49
Q

Describe the general principles of management of FGR pregnancies

A

‘Index’ pregnancy (CTG, serial fetal biometry, fetal doppler, BPP)
Ultrasound screen at 24w for ‘at risk’ pregnancies
Deliver at or after 28w, or after 500g (C-section for compromised foetuses)

50
Q

What is BPP?

A

Fetal biophysical profile

51
Q

When would you deliver a baby before it is due?

A

If there is evidence of fetal compromise on CTGs
Abnormal Dopplers
Abnormal ultrasounds
Maternal compromise

52
Q

What should be administered if gestation is prior to 36 weeks?

A

Corticosteroids to induce surfactant production to help the baby breatheee

53
Q

What will affect the mode of delivery?

A 
Gestation of the pregnancy
Condition of the pregnancy
Cervix condition
Presentation of fetus
Other factors e.g. oligohydramnios / cord compression
54
Q

Compare early IUGR to late IUGR

A

Low IUGR:
Low incidence
High correlation to maternal disease e.g. pre-eclampsia
Difficult to balance risk of severe prematurity and morbidity with risk of IUD

Late IUGR:
More common (5-7%)
Rarely correlated with Pre-eclampsia
Difficult to differentiate from constitutionally SGA
Easier to manage by delivery but difficult to tell when and how it should be done

55
Q

Pre-eclampsia is associated with IUGR at which stage?

A

Early IUGR

RDA (13 decks)

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