FGR Flashcards
Why is FGR such a problem
Can lead to stillbirths
What is the rate of stillbirth normally vs is FRG
5/1000 vs 10/1000
What causes hypoperfusion of baby from placenta
Cytotrophoblasts not invading far enough into spiral arteries —> increased resistance in BVs
Causes of FGR
Reduced blood flow to uterus / placenta
Placental abruption
Chromosomal anomaly
Foetal infection in PROM
Multiple preg
Smoking / drugs
Undernourishment of mother
Maternal anaemia
Pre eclampsia / CKD / AID
What is FGR associated with in practice
Lots unknown
Pre eclampsia
APH
Smoking
Define SGA
Infant born under 10th centile / <2.5kg
What is FGR
foetus failed to reach growth potential
How is SGA different from FGR
SGA is constitutionally small and can be normal
What does growth represent in terms of pregnancy
Placental function
What does antenatal screening look for
Pre eclampsia
IUGR
When is FGR apparent
After 20 weeks
List normal fundal heights of preg
12 weeks = symphysis pubis
16 weeks = between the 2
22 weeks = umbilicus
22 to 36 weeks = weeks of gestation
When is SFH not useful
High BMI
Fibroids
Multi preg
Transverse lie
3 elements of USS for FGR
foetal measurements
Amniotic fluid assessment
Dopplers
What foetal measurements are done
Abdo circ
EFW
When would amniotic fluid assessment be different
PROM
Oligohydramnios (<5th centile)
What 2 dopplers are done
Maternal uterine artery
Umbilical artery
When is uterine artery Doppler done
20-24 weeks ONLY
What is uterine artery Doppler done for
High risk IUGR
Resistance of UAs
What does umbilical artery Doppler show
Foetal compromise
When is umbilical artery Doppler done
24+ weeks too
Describe good / bad / very bad umbilical artery outcomes
Good = present end diastolic flow
Bad = absent EDF
Very bad = reversed EDF
How bad is raised pulsatility index
Between absent and normal EDF
What was included in the saving babies lives care bundle
Reduce smoking
Risk assess and surveillance of suspected FGR
Increase awareness of reduced foetal movements
Effective foetal monitoring during labour
Reduce pre term birth
What are the moderate risk factors for FGR
Prev SGA or prev AGA stillbirth
Smoker / drugs
>40 years old
What are the more severe risk factors for FGR
Medical conditions - CKD, HTN, AID
Prev FGR or SGA stillbirth
PAPPA <5th centile
Echogenic bowel
EFW <10th centile
Mx of FGR
aspirin
Uterine artery Doppler
Serial USS (2 weeks apart)
When is CTG done in FGR
if it’s really bad later on in preg
Why is CTG not done routinely for FGR
CTG is looking for hypoxia acutely but FGR is chronic so won’t be picked up
Can be falsely reassuring
When is an elective C section done for FGR
39 weeks
Why is C section not done earlier / later for FGR
Earlier - risk of TTN
Later - risk of spontaneous labour
Can too many contractions be bad? Why/why not?
Yes - can cause hypoxia to newborn due to reduced blood flow
When is oligohydramnios common
FGR and PPROM
When is polyhydramnios common
GDM, T1DM, placental abruption, premature labour
How does the placenta get delivered (how does it come out uterus)
Uterus contracts and placenta peels off the surface
