Gestational Weight Abnormalities Flashcards
What is small for gestational age?
A fetus that measures below the 10th centile for their gestational age
What is severe small for gestation age?
A fetus below the 3rd centile for their gestational age
What are the two causes for a small gestational age?
Constitutionally Small
Fetal Growth Restriction
How do we identify if the cause for a small gestational age is constitutional?
They are identified by small size at all stages but growth following the centiles
What does a constitutional cause for a small gestational age mean?
There is no pathology present - runs in the familiy
What does a fetal growth restriction cause for a small gestational age mean?
There is a small fetus due to a pathology reducing the amount of nutrients and oxygen being delivered to the fetus through the placenta
What are the two categories of fetal growth restriction causes for a small gestational age?
Placenta Mediated Growth Restriction
Non-Placenta Mediated Growth Restriction
What is placenta mediated growth restriction?
It refers to conditions that affect the transfer of nutrients across the placenta
What are the five placenta mediated growth restriction causes?
Maternal Alcohol
Maternal Smoking
Anaemia
Malnutrition
Diabetes
What is non-placenta mediated growth restriction?
It refers to pathology of the fetus
What are the three non-placenta mediated growth restriction causes?
Structural Abnormalities
Genetic Abnormalities
Fetal Infections
What are the five investigations used to diagnose small for gestational age?
Ultrasound Scan
Uterine Artery Doppler
Amniotic Fluid Volume
Cardiotocography
Karyotyping
What two measurements are obtained from an ultrasound scan to diagnose small for gestational age?
Estimated fetal weight (EFW)
Fetal abdominal circumference (AC)
What chart is plotted after an ultrasound scan to diagnose small for gestational age?
Customised growth charts
What are customised growth charts?
Charts to assess the size of the fetus based on the mother’s height, weight, ethnicity and parity
How do we conservatively manage patients with a small gestational age?
It involves treating modifiable risk factors, such as smoking cessation and optimising maternal disease
It also involves close monitoring using a uterine artery doppler
When do we consider early delivery of small gestational age babies?
When growth is static on the growth charts or other problems are identified
What delivery method is used in small gestational age babies before 37 weeks gestation?
C-section
What delivery method is used in small gestational age babies after 37 weeks gestation?
We offer labour induction with vaginal delivery
What do we prescribe patients when delivery is considered between 24 and 36 weeks’ gestation (small for gestational age)? Why?
A single course of antenatal steroids should be given
This is to promote fetal lung growth, reducing the risk of respiratory distress syndrome
What are the four short-term complications of small gestational babies?
Stillbirth
Neonatal Hypothermia
Neonatal Hypoglycaemia
Birth Asphyxia
What are the four long-term complications of small gestational babies?
Type Two Diabetes
Obesity
Hypertension
Cancer
What is large for gestational age (macrosomia)?
It is defined when the weight of the newborn is more than 4.5kg at birth
During pregnancy, an estimated fetal weight above the 90th centile is large
What are the four causes of large gestational age?
Constitutionally Large
Maternal Diabetes
Overdue Baby
Maternal Obesity
What two investigations are used to diagnose large gestational age?
Ultrasound Scan (same as small gestational age)
Oral Glucose Tolerance Test
What is an oral glucose tolerance test used to diagnose large for gestational age?
To identify a potential underlying cause for macrosomia – gestational diabetes
How do we deliver large gestational age babies?
Normal vaginal delivery
What is the main complication of delivery of large gestational babies? How do we reduce this risk?
Shoulder dystocia
Delivery is conducted on a consultant lead unit and the third stage of labour is managed actively
What are the four maternal complications of large gestational age?
Shoulder Dystocia
Failure to Progress
Perineal Tears
Postpartum Haemorrhage
What are the four fetal complications of large gestational age?
Birth Injury
Neonatal Hypoglycaemia
Obesity
Type Two Diabetes
