Interuterine Growth Restriction

Question 1

How is growth within pregnancy monitored?

Answer 1

Symphasis-fundal height
Head  circumference
Abdominal circumference (glycogen deposition)
Femur length 
Estimated foetal weight chart

Question 2

How is EDD and a pregnancy time-line calculated?

Answer 2

12 week dating scan (between 10 - 14 weeks)

LMP

Question 3

How does SFH work?

Answer 3

+/- 3cm equal to the number of weeks pregnant AFTER 24 weeks - (i.e 28 weeks gestation = 25-31cm)
Anything above 31 = large for dates
Anything below 25 = small for dates

Question 4

What happens if a foetus is found to be ‘small’ for dates?

Answer 4

Monitored via serial ultrasound scans every 4 weeks

Question 5

Define ‘small for gestational age’?

Answer 5

1. Constitutionally small = foetus is small for gestational (expected size) however has a normal growth rate over time
2. Growth restricted (IUGR) - foetus is small for gestational (expected size) however the growth rate slows with time

Question 6

Which parameters are clinically used for predicting the size of the baby?

Answer 6

Abdominal circumference

Estimated foetal weight

Question 7

At which point in gestation are steroids not needed to help lung surfactant production?

Answer 7

35+6 weeks gestation

Question 8

Name 5 complications attributed to IUGR?

Answer 8

Foetal distress within labour (intrapartum asphyxia)
Postnatal hypoglycaemia
Postnatal hypocalcaemia
Meconium apsiration (chemical pneumonitis)
Interuterine death

Question 9

Name 8 maternal risk factors associated with IUGR?

Answer 9

Smoking and cocaine
Over 40 maternal age
Poor diet within pregnancy
Extremities of BMI
PET/PIH
APH
Low PAP-A (pregnancy associated plasma protein A) in 1st trimester
Previous SGA baby

Question 10

Name 5 maternal conditions that may cause IUGR?

Answer 10

Diabetes
CKD
SLE
CVD
Chronic hypertension

Question 11

What four parameters are within a customised growth chart?

Answer 11

Height
Weight
Parity
Ethnicity

Question 12

What aspects of the gynaecological history are important to obtain from the patient?

Answer 12

Any history of fibroids/cysts which may indicate a large for dates palpation of the abdomen within symphasis-fundal height

Question 13

Describe the most common foetal cause for olygohydramnios?

Answer 13

Foetal kindneys inability to produce urine and liquor - renal agenesis

Question 14

Describe the most common foetal cause for polyhydramnios?

Answer 14

Foetal inability to swallow - oespohgeal atresia

Question 15

Name a common drug associated with oligohydramnios?

Answer 15

Atenolol

Question 16

If polyhydramnios is suspected which investigations should be taken?

Answer 16

GTT - ?gestational diabetes

If NON-gestational diabetic - check maternal IgA and IgM antibodies for rubella/CMV screening

Question 17

Which investigations would help indicate PET?

Answer 17

Urine dipstick and double BP check
FBC - high haematocrit/low platlets
LFTs - Increased ALK/ALT
U+E - Increased createnine/ PCR value increased (should be 6 or lower)