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Year 2 - RDA > Foetal Growth > Flashcards

Foetal Growth Flashcards

1
Q

Define foetal growth

A

The increase in mass that occurs between the end of the embryonic period and birth

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2
Q

How do you determine external size?

A

via. Symphysis Fundal Height (SFH)

Distance between pubic symphysis & fundus of uterus

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3
Q

Why might you get errors in size due to it being LOWER than they should be?

A
  • Wrong LMP date
  • Baby in a transverse line
  • Complications including oligohydramnios (low levels of amniotic fluid levels)
  • Baby that is small for GA (SGA)
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4
Q

Why might you get errors in size due to it being GREATER than they should be?

A
  • Wrong LMP date
  • Multiple pregnancy
  • Maternal obesity
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5
Q

What complications could arise due to the external measurement of size via. SFH?

A
  • Molar pregnancy
  • Fibroids
  • Polyhydraminos
  • Baby that is large for GA (LGA)
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6
Q

Issue with historical data on foetal size and growth and what’s it been replaced with?

A

Bases on miscarriages
• did NOT take into account the causative relationship betw. the LOW FOETAL GROWTH leading to miscarriages

HENCE replaced by UTERO SCANNING DATA

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7
Q

2 main factors important for foetal growth?

A
  1. Genetic potential
    • derived from parents
  2. Substrate supply
    • sufficient nutrients essential to achieve genetic potential
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8
Q

What can Ultrasound Scanning (US) be used to idenfity?

A
  • Bipartietal Diameter (BPD)
  • Head Circumference (HC)
  • Abdominal Circumference (AC)
  • Femur Length (FL)

ALL OF THESE COMBINE TO GIVE:
Estimated Foetal Weight (EFW)

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9
Q

What is US used mainly to assess?

A

OVERALL foetal well-being

i.e. chromosomal abnormalities

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10
Q

What can be obtained from each of the US measurements?

A

Normative growth curves

Due to differences in people, customised foetal growth charts may be used
• based on foeta weight curves for normal pregnancies
• Adjusted to reflect maternal constitutional variation (i.e. mother weight)
• Optimised (w. curves free from data influences by pathological influences)

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11
Q

Overall average rate at which an infant gains weight?

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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12
Q

Normal foetal growth is characterised by 3 main phases…..

A

Cellular Hyperplasia
• 4-20 weeks

Hyperplasia & Hypertrophy
• 20-28 weeks

Hypertrophy dominates
• 28-40 weeks
• hence why mid-3rd trimester is the GREATEST growth velocity

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13
Q

Issues with dating the pregnancy?

A

Hard to date due to issues such as LMP date

BUT important to get it right to classify GA

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14
Q

Best practice to date pregnancy?

A

Ultrasound

Determine the CROWN-RUMP LENGTH of foetus
• end of 1st trimester
• variations in foetal size are MORE LIMITED at this stage so more accurate date

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15
Q

2 types of factors affecting foetal growth?

A
  1. Maternal factors

2. Feto-placental factors

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16
Q

What are some Maternal Factors influencing foetal growht?

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
• e.g. lead to FAS (foetal alcohol syndrome)

 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

17
Q

What are some Feto-placental factors affecting 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 that acts to:
• Increase mitotic drive
• Increase nutrient availability for tissue accretion
o Little effect on tissue differentiation (this is mediated by cortisol)

18
Q 
Define
SGA
IUGR
LBW
VLBW
ELBW
A

SGA
• Small for GA
• birth weight <10th centile

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

LBW
• Low Birth-Weight

VLBW
• Very LBW

ELBW

LAST 3 do NOT take GA into account
• simply refer to infants weight at delivery

19
Q

Why is it important that the last 3 definitions do NOT take GA into account?

A

Important to determine between pre-term babies that are of a:
• LBW
and those that are
• IUGR (greater risk)

20
Q

Explain how the growth axis can be used to capture babies that are IUGR

A

Age on x-axis and weight on y-axis

The 10th centile is most sensitive and the 3rd centile is most specific
• 10th centile will capture all babies with IUGR but also those that are SGA
 i.e. captures false +ve
• 3rd centile captures IUGR but also misses some
• No consideration of genetics

21
Q

When is IUGR used and outcomes of it?

A

IUGR is only used for DEFINITE evidence that growth has altered

  • Most common cause of still-born babies
  • Have increased incidence of complications (medlearn!)
  • Subsequent pregnancies may also be affected
22
Q

Causes of IUGR?

A

Generally, develops in the 2nd and 3rd trimesters
• as the 1st stage focuses on embryology (up to 50g weight)

Divided into 4 categories:
 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

23
Q

What is Pre-eclampsia

A

Hypertension

&

Proteinuria
• (protein in the urine)

24
Q

Link between IUGR and pre-eclampsia?

A

There is a CLOSE LINK between IURG and pre-eclampsia

Due to 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

25
Q

Management of IUGR and pre-eclamptic pregnancies?

A

Corticosteroids should be administered
• at gestations <36 weeks
•to improve neonetal wellbeing, particuarly the LUNGS

For pre-eclampsia
• DELIVERY is best treatment as placenta is the 1o cause

Year 2 - RDA (6 decks)

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