Foetal Abnormalities And Maternal Infections Flashcards
Define ‘Small for Gestational Age’
Infant with weight <10th centile for its gestational age
State three types of Small for Gestational Age
Normal/Constitutionally Small (growing at a normal rate but just small)
Placenta Mediated Growth Restriction (normal growth that initially slows due to Placenta Insufficiency - substance abuse/autoimmune/diabetes/renal disease)
Non Placenta Mediated Growth Restriction (Chromosomal/Structural Abnormalities)
Give three minor and three major risk factors for Small for Gestational Age
Minor - Nulliparity, Previous Pre-Eclampsia
Major - Smoker>10 per day, Maternal Age>40, Previous SGA baby
How would you investigate a suspected SGA baby?
Ultrasound Scan
Uterine Artery Doppler
Karyotyping
Why is the HC:AC ratio important in Small for Gestational Age babies?
If constitutionally small, the ratio is likely to be similar
If placental insufficiency it is likely to be asymmetric/head sparing
How often should a Small for Gestational Age baby be monitored?
At least every 14 Days
When should an SGA baby be delivered by C Section before 37 weeks?
If Absent Doppler or Reverse End Diastolic
State four complications of an Small for Gestational Age baby
Asphyxia
Hypothermia
Cerebral Palsy
Precocious Puberty
Give three examples of sensitising events with Red Blood Cell Isoimmunisation
Antepartum Haemorrhage
Abdominal Trauma
Delivery
What is Anti- D and when should it be given?
Binds to Rhesus D antibodies preventing immune response
Should be given after any sensitising event in Rhesus Negative Women
Even if no sensitising event, all Rhesus Negative women should receive at 28 and 32 weeks
What is the Foetomaternal Haemorrhage Test?
Assesses how much foetal blood loss has entered maternal circulation
If occurring after 28 weeks, used to assess how much Anti D is required
What sort of sensitising events could occur before 12 weeks
Ectopic Pregnancy
Molar Pregnancy
Termination of Pregnancy
Heavy Bleeding
Define Prematurity
Delivery between 24 and 37 weeks gestation
Very preterm is <32 weeks
What is PPROM
Rupture of foetal membranes before 37 weeks and before labour onset
Give 4 associations of prematurity
Foetal Growth Restriction
Iatrogenic
Cervical Incompetence
Systemic Maternal Infection
Name three ways you can identify a woman at risk of prematurity
Clinical Risk Scoring (Smoking Status, Socioeconomic, PMH)
Cervical Assessment (short cervix equals high risk)
Foetal Fibronectin (maintains placental decidual matrix)
Give three ways that you could PREVENT a preterm labour
Antibiotics Cervical Cerclage (Purse String) Progesterone (Antagonises Oxytocin, Anti Inflammatory, Maintains Integrity)
Give three ways you could INHIBIT pre term labour (AKA tocolysis)
Nifedipine Oxytocin Antagonists (Atosiban) COX inhibitors (may cause problems with closure of Ductus Arteriosus - required to be patient until birth)
What is Prolonged Pregnancy?
Refers to the 5-10% of pregnancies persisting beyond 42 weeks gestation
Give three clinical features of Prolonged Pregnancy
Macrosomia
Reduced Foetal Movement
Meconium
How would you manage Prolonged Pregnancy
Membrane sweeps at 40 weeks in nulliparous and 41 weeks in parous
Induction of labour between 41-42 weeks
If any signs of placental insufficiency - deliver
