HD PBL 2

Question 1

What is SGA?

Answer 1

Weighs <10th centile for the appropriate gestation (in the bottom 10% of babies/foetuses that age)

Question 2

What kind of miscarriage was shown in this scenario? explain your answer.

Answer 2

Threatened miscarriage
Painless bleeding - brief and not repeated
(on examination uterus should be normal/expected size and cervical os closed)

Question 3

In incomplete miscarriages there are retained products of contraception. Explain how misoprostol can be used to remove these.

Answer 3

Misoprostol = prostaglandin analogue

Attaches to myometrial cells causing them to contract = expulsion of tissues

Question 4

How does Parvovirus present (in children/infants)?

Answer 4

‘slapped cheek’ look

Question 5

Which infections in pregnancy are harmful to the foetus?

Answer 5

TORCHeS:

1. toxoplasmosis
2. other (HIV, HSV, VZV, Parvovirus)
3. rubella
4. CMV
5. hepatitis
6. syphilis

Question 6

How is fundal height measured? What value would you expect for a foetus of 33 weeks?

Answer 6

distance from the pubic symphysis to the highest part of the uterus
33 week = 33 cm (+/- 2cm)

Question 7

How does the HC/AC ratio compare in symmetrical and asymmetrical IUGR?

Answer 7

Symmetrical = HC:AC = 1 (dangerous, no sparing of brain)
Asymmetrical = HC:AC >1 (shows brain is being spared = better prognosis)

Question 8

How can ultrasound estimate foetal weight?

Answer 8

1. biparietal diameter
2. head circumference
3. abdomen circumferece
4. femur length

Question 9

What tests can monitor the health of the foetus? (not about growth, but organ health)

Answer 9

1. CTG (monitor foetal HR)
2. foetal movements
3. foetal breathing movements
4. amniotic fluid volume (oligohydramnios indicative of congenital defects, issues with kidneys, poor prognosis)

Question 10

When labour is being induced early, glucocorticoid injections are given, why is this?

Answer 10

1. enhance lung maturity

2. protect against intracranial haemorrhage and necrotising enterocolitis

Question 11

What are the main characteristics of pre-eclampsia?

Answer 11

HTN + proteinuria

Question 12

Why does pre-eclampsia occur? (pathophys basically)

Answer 12

due to abnormal adaptation to trophoblast invasion, proliferation and differentiation

Question 13

How is pre-eclampsia managed and how is it cured?

Answer 13

Management:

• timely delivery (most important)
• antihypertensives + anticonvulsants
• 4 hourly BP
• daily urinalysis
• LFTs etc

Cure:
- delivery of baby

Question 14

What is ELBW?

Answer 14

Extremely low birth weight = <1000g

Question 15

Name 3 possible causes of IUGR?

Answer 15

Any from:

• pre-eclampsia
• infection
• placental insufficiency
• chromosomal abnormalities
• maternal factors (drugs, alcohol, smoking, poor nutrition etc)

Question 16

What is the most reliable method for assessing foetal growth? Name one drawback.

Answer 16

Ultrasonography

Drawback: high incidence of false positives

Question 17

List some complications IUGR babies may experience later in their adult life.

Answer 17

T2D
HTN
Cardiovascular disease