Fetal Problems

Question 1

Small for gestational age definition

Answer 1

Expected birth weight is less than the 10th percentile for that particular gestational age

Question 2

Intrauterine growth restriction definition

Answer 2

The expected growth rate of fetus slows as pregnancy goes on indications of a pathological cause. Neonates have features of poor development.

Question 3

Low birth weight definition

Answer 3

Birth weight less than 2500g irrespective of gestational age, sex, race, and clinical features

Question 4

Fetal macrosomia definition

Answer 4

Macrosomia = birth weight over 4500g. Relates to

birthweight, therefore a fetus cannot technically be described as macrosomic until it is born

Question 5

Large for dates definition

Answer 5

Expected birth weight is over the 90th percentile for that particular gestational age

Question 6

Factors influencing intra-uterine growth restriction and small for gestational age

Answer 6

Maternal = smoking, alcohol consumption, malnutrition and poor diet, low BMI before pregnancy, under 17yrs or over 40yrs, cocaine use.
Fetal = multiple pregnancy, antepartum haemorrhage, chromosomal abnormalities, 
Pathologies = anaemia, pre-eclampsia, renal disease, antiphospholipid syndrome, Diabetes, HTN.

Question 7

Causes of decreased fetal movements and management

Answer 7

Fetal position.
Maternal obesity.
Fetal sleeping.
Alcohol, corticosteroids or maternal substance misuse.
Oligo/poly-hydramnios.
Maternal or fetal anaemia.
Placenta position.
Fetal death.
Mx = Doppler auscultation. CTG for at least 20mins. US scan.

Question 8

Methods of fetal monitoring

Answer 8

Cardiotocography (CTG)
Fetal ECG (direct via scalp (gold standard) or indirect via abdo)

Question 9

Analysis of a CTG

Answer 9

Baseline HR (bpm)
Variability in HR
Presence of accelerations
Presence fo decelerations

Question 10

Causes of a decrease in fetal HR variability

Answer 10

Sleeping baby, maternal dehydration, morphine and analgesia use.

Question 11

Reassuring signs on CTG

Answer 11

110-160bpm HR
Up to 5bpm in variability
No decelerations
Presence of accelerations (due to uterine contractions)

Question 12

Causes of decelerations

Answer 12

head compression, cord compression, utero-placenta insufficiency.

Question 13

Classification of CTG

Answer 13

Measurements can be either reassuring, non-reassuring or abnormal and then collected info can be normal (all normal), suspicious (1 non-reassuring feature) or pathological (2 or more non-reassuring features or 1 or more abnormal features).

Question 14

Types of lie for fetus

Answer 14

Normal = longitudinal
Transverse = fetus is at 90 angle to maternal plane.
Oblique = fetus is at 45 degree angle to maternal plane.

Question 15

Types of presentation and fetal lie which predisposes them.

Answer 15

Normal = vertex/cephalic from longitudinal lie.
Breech= from longitudinal lie. Frank, complete or footling.
Brow = head partially extended, forehead first.
Face = neck extended, face first.
Shoulder = from transverse lie, need c-section.

Question 16

Types of position of fetus

Answer 16

Normal = occiput-anterior.
Occiput posterior
Occiput transverse
Left or right positions possible.

Question 17

Different types of breech presentations

Answer 17

Meconium stained!!
Complete - flexion of legs at hip and knee, legs bent underneath baby, bum first.
Frank - flexion of leg at hip but extend at knee, pike like position.
Footling - one or both legs extended at hip and knee, foot first.

Question 18

Risk factors for an abnormal presentation

Answer 18

Multiple pregnancy, prematurity, macrosomia, fetal abnormality (hydrocephalus), placenta praaevia, Polyhydramnios, pelvic tumour.

Question 19

Complications of malpresentation and management

Answer 19

Cord prolapse
Placenta abruption
Fetal hypoxia
Fetal cervical cord injury
Prolonged labour

Question 20

Factors causing IUGR

Answer 20

MATERNAL = low socio-economic status, poor weight gain by mother during pregnancy. Maternal anaemia. Maternal smoking and drug use. Maternal co-morbidities e.g. HTN, DM, CVD.
PLACENTAL = pre-eclampsia, multiple pregnancy, uterine malformations, placenta accreta, placenta praevia.
FETAL = intrauterine infection, chromosomal abnormality.

Question 21

Factors which influence growth of fetus

Answer 21

Maternal nutrition/obesity.
Multiple pregnancy
Infections (CMV)
Smoking and drug use
Pre-exisiting maternal pathology e.g. renal disease, DM.
Congenital/genetic abnormalities of fetus.

Question 22

Investigating of IUGR

Answer 22

TVUS more regularly.
Uterine artery doppler - reduced blood flow due to poor trophoblast invasion.
Offer infection screening and karyotyping.

Question 23

Management of IUGR

Answer 23

Close monitoring.

Consider corticosteroids if less than 36weeks gestation.

Question 24

Describe the changes which occur to the fetal CVS system after birth

Answer 24

Umbilical vessels, ductus arteriosus, foramen ovale and ductus venosus constrict.

Question 25

Origin of the ligamentum teres

Answer 25

umbilical vein

Question 26

Origin of the ligamentum venosum

Answer 26

ducutus venosus

Question 27

Intervention for breech presentation

Answer 27

External cephalic version at 37 weeks,

Question 28

Contraindications for external cephalic version

Answer 28

Placenta praevia
Pre-eclampsia
Abnormal CTG
Membranes have ruptured
Uterine abnormality (bicornate)

Question 29

Test for fetal-maternal haemorrhage and to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream.

Answer 29

Kleihauer test