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LCRS RepDevAge > Foetal Growth > Flashcards

Foetal Growth Flashcards

1
Q

how can foetal size be determined externally?

A

Symphysis Fundal Height (SFH):

Distance between pubic symphysis and fundus of uterus.

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2
Q

why may the SFH be lower than it should be?

A
  • wrong LMP date
  • baby lies in a transverse line
  • oligohydramnios (low amniotic fluid levels)
  • baby is small for GA.
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3
Q

why may the SFH be higher than it should be?

A
  • wrong LMP date
  • multiple pregnancy
  • molar pregnancy
  • maternal obesity
  • polyhydramnios (excess amniotic fluid)
  • large for gestational age
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4
Q

what complications affect the SFH reading (larger than usual)?

A
  • molar pregnancies
  • fibroids
  • polyhydramnios
  • llarge baby for GA
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5
Q

what are the main factors important for foetal growth?

A
  • genetic potential (from the parents)

- substrate supply (derived from placenta vasculature)

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6
Q

when does foetal growth occur?

A

end of embryonic period to birth

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7
Q

what can be identified using ultrasound scanning?

A 
o Crown- Rump length 
o Biparietal diameter (BD).
o Head circumference (HC).			
o Abdominal circumference (AC).
o Femur length (FL).

Combines into Estimated Foetal Weight (EFW).

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8
Q

what is ultrasound mainly used for?

A
  • overall foetal wellbeing (i.e. chromosomal abnormalities)
  • management of abnormal growth
  • prediction of metabolic compromise
  • anticipate premature delivery
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9
Q

what are customised foetal growth charts based on?

A

o Based on foetal weight curves for normal pregnancies.
o Adjusted to reflect maternal constitutional variation – i.e. mother weight.
o Optimised – with curves free from data influenced by pathological factors.

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10
Q

how does the growth velocity change with GA?

A 
o 14-15 weeks 	
-->5g/day.
o 20 weeks	
--> 10g/day.	
o	32-34 weeks
-->30-35g/day.			 
o >34 weeks
 -->velocity decreases.

Fastest velocity is mid-third trimester.

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11
Q

what are the phases of normal foetal growth?

A 
o Hyperplasia (rapid cell division)
– 4-20 weeks.

o Hyperplasia and hypertrophy
– 20-28 weeks.

o Hypertrophy (most foetal weight gain)
– 28-40 weeks
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12
Q

why is it hard to date a pregnancy? why is it important however?

A

there are issues knowing the LMP date i.e. planned vs. unplanned pregnancies, oral contraceptive use

important to classify GA and get it right

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13
Q

how can pregnancy be dated best?

A

ultrasound
– determining crown-rump length of foetus at the end of 1st trimester

variations in foetal size are more limited at this stage so more accurate date

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14
Q

what are some specific maternal factors affecting foetal growth?

A

 Poverty
– more likely to be young (low birth weight) and be less educated on risks.
 Mother’s age
– too young or too old can impact baby health.
 Drug use and alcohol.
 Smoking and nicotine.
 Diseases.
 Mother’s diet and physical health
– MALNUTRITION is the most important factor in baby growth.
 Mother’s prenatal depression.
 Environmental toxins.

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15
Q

what are the foeto-placental factors influencing foetal growth?

A 
 Different genotypes.
 Gender
 – males tend to be bigger than females.
 Previous pregnancy 
– infants are heavier in the 2nd and subsequent pregnancies. 
 Hormones
 – one important hormone is IGF-1
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16
Q

what are the effects of IGF-1 in foetal growth?

A
  • Increase mitotic drive.
  • Increase nutrient availability for tissue accretion.

Little effect on tissue differentiation (this is mediated by cortisol).

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17
Q

what mediates tissue differentiation?

A

cortisol

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18
Q

SGA

A

Small for Gestational Age
– infant has a birth weight <10th centile

(AKA “Small for Dates”).

19
Q

what is the definition of IUGR/FGR?

A

failure of the infant to achieve its predetermined (genetic) potential for a variety of reasons

Intrauterine growth restriction - the term is only used for those with definite with IUGR

20
Q

LBW

A

Low Birth-Weight
– <2,500g
most LBW are not FGR

does not consider GA

21
Q

VLBW

A

Very Low Birth-Weight
- <1,500g

does not consider GA

22
Q

ELBW

A

<1,000g

does not consider GA

23
Q

relationship between foetal growth and GA

A

A baby at term at 2,500g would be SGA but a baby of 2,500g ay 33 weeks’ delivery is normal (i.e. preterm)

  • important to determine between pre-term babies that are of a LBW and those that are IUGR (at a greater risk).
24
Q

what is the most sensitive centile in the IUGR age/weight graph?

A

10th

10th centile will capture all babies with IUGR but also those that are SGA.

i.e. captures false +ve.

25
Q

what is the most specific centile in the IUGR age/weight graph?

A

3rd

3rd centile captures IUGR but also misses some.
no genetics considered

26
Q

what is IUGR a common factor in?

A

stillborns

has serious consequences on post birth survival
subsequent pregnancies may be affected by IUGR

27
Q

when does IUGR often occur?

A

develops in the 2nd and 3rd trimesters as the 1st stage focuses on embryology

28
Q

what are the causes of IUGR?

A

 Maternal medical factors
– infection, pre-eclampsia, uterine abnormalities, etc.

 Maternal behavioural factors – i.e. alcohol.

 Foetal factors
– i.e. multiple pregnancy.

 Placental factors
– i.e. placental cysts, impaired trophoblast invasion.

29
Q

what are the short term problems with LBW/prematurity/FGR?

A 
Respiratory distress
Intraventricular Sepsis 
Hypoglycaemia
Necrotising Jaundice
Electrolyte imbalance
haemorrhage
enterocolitis
30
Q

what are the medium term problems with LBW/prematurity/FGR?

A

Developmental delay
Respiratory
Special needs schooling

31
Q

what are the long term problems with LBW/prematurity/FGR?

A

foetal programming

32
Q

what is the link between IUGR and pre-eclampsia?

A

main cause of pre-eclampsia is diminished remodelling of spiral arteries by cytotrophoblasts.

This causes decreased blood flow and hence decreased nutrient supply to the placenta and foetus.

33
Q

what are the pros and cons of SFH use?

A 
pros:
• Simple 
• Inexpensive
cons: 
• Low detection rate: 50-86%
• Great inter-operator variability
• Influenced by a number of factors (BMI, foetal lie, amniotic fluid, fibroids)
34
Q

what are some consequences of abnormal foetal growth?

A
  • neonatal hydrocephalus
  • achrondoplasia
  • macrosomia
35
Q

what are the consequences of pre-eclampsia?

A

hypertension and proteinuria.

36
Q

what would a blood pressure in pre-eclampsia (PET)?

what is the other sign for pre-eclampsia?

A

> 140/90

significant proteinuria (>300mg/day)

37
Q

what are some maternal factors affecting foetal growth?

A

medical:

  • diabetes mellitus
  • chronic hypertension
  • chronic infections

behavioural:

  • smoking
  • poor nutrition
  • drugs
  • living in altitude
38
Q

what are some foetal factors affecting foetal growth?

A
  • chromosomal abnormalities
  • multiple pregnancies
  • structural abnormalities
39
Q

what are some placental factors affecting foetal growth?

A

impaired trophoblast invasion

40
Q

what facilitates spiral artery remodelling?

A

cytotrophoblasts

41
Q

how is a mother screened for pre-eclampsia risk?

A
  • look for systemic diseases
  • pHx of pre-eclampsia in previous pregnancies
  • uterine artery Doppler scan (identify high resistance blood flow)
42
Q

what must be given to a prematurely delivered baby (<30 weeks)?

A

glucocorticoids

43
Q

what is the difference in handling a late and early IUGR?

A

late IUGR is easier to deal with than an early IUGR as this is most likely linked with pre-eclampsia

LCRS RepDevAge (9 decks)

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