Foetal Abnormalities And Maternal Infections

Question 1

Define ‘Small for Gestational Age’

Answer 1

Infant with weight <10th centile for its gestational age

Question 2

State three types of Small for Gestational Age

Answer 2

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)

Question 3

Give three minor and three major risk factors for Small for Gestational Age

Answer 3

Minor - Nulliparity, Previous Pre-Eclampsia

Major - Smoker>10 per day, Maternal Age>40, Previous SGA baby

Question 4

How would you investigate a suspected SGA baby?

Answer 4

Ultrasound Scan
Uterine Artery Doppler
Karyotyping

Question 5

Why is the HC:AC ratio important in Small for Gestational Age babies?

Answer 5

If constitutionally small, the ratio is likely to be similar

If placental insufficiency it is likely to be asymmetric/head sparing

Question 6

How often should a Small for Gestational Age baby be monitored?

Answer 6

At least every 14 Days

Question 7

When should an SGA baby be delivered by C Section before 37 weeks?

Answer 7

If Absent Doppler or Reverse End Diastolic

Question 8

State four complications of an Small for Gestational Age baby

Answer 8

Asphyxia
Hypothermia
Cerebral Palsy
Precocious Puberty

Question 9

Give three examples of sensitising events with Red Blood Cell Isoimmunisation

Answer 9

Antepartum Haemorrhage
Abdominal Trauma
Delivery

Question 10

What is Anti- D and when should it be given?

Answer 10

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

Question 11

What is the Foetomaternal Haemorrhage Test?

Answer 11

Assesses how much foetal blood loss has entered maternal circulation

If occurring after 28 weeks, used to assess how much Anti D is required

Question 12

What sort of sensitising events could occur before 12 weeks

Answer 12

Ectopic Pregnancy
Molar Pregnancy
Termination of Pregnancy
Heavy Bleeding

Question 13

Define Prematurity

Answer 13

Delivery between 24 and 37 weeks gestation

Very preterm is <32 weeks

Question 14

What is PPROM

Answer 14

Rupture of foetal membranes before 37 weeks and before labour onset

Question 15

Give 4 associations of prematurity

Answer 15

Foetal Growth Restriction
Iatrogenic
Cervical Incompetence
Systemic Maternal Infection

Question 16

Name three ways you can identify a woman at risk of prematurity

Answer 16

Clinical Risk Scoring (Smoking Status, Socioeconomic, PMH)

Cervical Assessment (short cervix equals high risk)

Foetal Fibronectin (maintains placental decidual matrix)

Question 17

Give three ways that you could PREVENT a preterm labour

Answer 17

Antibiotics
Cervical Cerclage (Purse String)
Progesterone (Antagonises Oxytocin, Anti Inflammatory, Maintains Integrity)

Question 18

Give three ways you could INHIBIT pre term labour (AKA tocolysis)

Answer 18

Nifedipine
Oxytocin Antagonists (Atosiban)
COX inhibitors (may cause problems with closure of Ductus Arteriosus - required to be patient until birth)

Question 19

What is Prolonged Pregnancy?

Answer 19

Refers to the 5-10% of pregnancies persisting beyond 42 weeks gestation

Question 20

Give three clinical features of Prolonged Pregnancy

Answer 20

Macrosomia
Reduced Foetal Movement
Meconium

Question 21

How would you manage Prolonged Pregnancy

Answer 21

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