Growth monitoring, stillbirth

Question 1

Foetal indications for growth scans (current pregnancy)

Answer 1

• First fundal height measurements at 26-28w below 10th centile
• Static/ slow/ excessive growth
• Suspected polyhydramnios/ oligohydramnios
• Suspected/ confirmed foetal anomaly
• Multiple pregnancy

Question 2

Maternal indications for growth scans (current pregnancy)

Answer 2

• Maternal smoking (including smoking while trying to get pregnant)
• Late booker (20+ weeks gestation)
• Substance misuse

Question 3

Past obstetric history indications for growth scans

Answer 3

• Previous unexplained stillbirth

* Previous birthweight <10th centile

Question 4

Past gynae history indications for growth scans

Answer 4

• Pre-existing diabetes
• Chronic illness
• Uterine fibroids 6+ cm
• BMI >35

Question 5

What 3 measurements are made in a foetal growth scan

Answer 5

1. head circumference
2. abdominal circumference
3. femur length

Question 6

Components of customised growth chart

Answer 6

• Mum’s ethnicity
• Mum’s weight and height
• Parity

Note: does NOT include gender

Question 7

Definition of Small for Gestational Age

Answer 7

Weight of foetus <10th centile for its gestation

Question 8

Definition of IUGR

Answer 8

Foetus failed to reach growth potential (based on customised growth chart)

Question 9

Non-pathological causes of a small baby

Answer 9

• Low maternal height & weight
• Asian ethnicity
• Nulliparous
• Female foetus

Question 10

Pathological causes of IUGR

Answer 10

• Maternal renal, autoimmune disease, pre-eclampsia
• Multiple pregnancy
• Smoking, drug usage
• Infection eg CMV
• Extreme exercise, malnutrition
• Congenital abnormalities

Question 11

Which type of scan is best for assessing placental dysfunction after 34 weeks

Answer 11

Foetal MCA Doppler

Question 12

How often are growth scans in SGA-only baby

Answer 12

2-3 weekly intervals

Question 13

How often are growth scans in IUGR baby

Answer 13

Scan at least 2x a week.
Daily CTG if <32 weeks

If absent end diastolic flow seen, admit mum to hospital. give steroids.

Question 14

Definition of stillbirth

Answer 14

Foetus delivered after 24weeks with no signs of life

Question 15

Risk factors for stillbirth

Answer 15

• IUGR, particularly due to smoking, multiple pregnancy
• Congenital abnormalities
• Diabetes, autoimmune disease, sickle cell disease, renal disease
• GDM, pre-eclampsia leading to placental insufficiency
• Infection
• Placental abruption

Question 16

When would you do an umbilical artery doppler

Answer 16

All growth scans

marker of foetal wellbeing at the time

Question 17

When would you do a uterine artery doppler

Answer 17

Screening tool at 23 weeks

if risk of IUGR

Question 18

When would you do a foetal MCA doppler

Answer 18

Suspected foetal ANAEMIA eg
• Maternal infection
• Foetal hydrops

Question 19

Feature of Potter syndrome (complication of oligohydramnios)

Answer 19

1. Pulmonary hypoplasia
2. Limb deformities
3. Characteristic facial features (flat nose, low-set ears)

Question 20

What might an abnormal uterine artery doppler indicate

Answer 20

1. Pre-eclampsia
2. IUGR
3. Placental abruption
4. Adverse neonatal outcomes in early 3rd trimester

Question 21

What might low PAPP-A indicate

Answer 21

1. Chromosomal abnormalities
2. High risk of IUGR
3. High risk of Placental abruption
4. High risk of Stillbirth