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Y2 LCRS 1 - RDA > Intrauterine Growth Restriction > Flashcards

Intrauterine Growth Restriction Flashcards

1
Q

What is the definition of SGA?

A

Infant has Birth weight < 10th centile

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2
Q

What is FGR?

A

Failure of the foetus to achieve predetermined growth potential for various reasons

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3
Q

What is the definition of Low Birthweight?

A

Less than 2500 g at delivery

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4
Q

What is the definition of very low birthweight?

A

Less than 1500g at delivery

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5
Q

What is the definition of extremely low birthweight?

A

Less than 1000g at delivery

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6
Q

Which centile for IUGR is the most sensitive?

A

10th centile
Will capture all babies with IUGR, but will also include those babies that are just SGA
*False positives

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7
Q

Which centile for IUGR is most specific?

A

3rd centile
All babies in 3rd centile have IUGR, but some IUGR babies may be missed
* False negatives

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8
Q

What are the short term problems of LBW/ FGR/ Pre-maturity?

A 
Respiratory distress
Intraventricular haemorrhage
Sepsis
Hypoglycaemia
Necrotising enterocolitis
Jaundice
Electrolyte imbalance
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9
Q

What are the medium term problems of LBW/FGR/ Prematurity?

A

Respiratory problems
Developmental delay
Special needs schooling

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10
Q

What are the long term problems of LBW/ FGR/ Prematurity?

A

Fetal programming

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11
Q

What are the maternal medical factors linked to IUGR, SGA?

A 
Chronic hypertension
Connective tissue disease
Severe chronic infection
Diabetes mellitus
Anaemia
Uterine abnormalities
Maternal malignancy
Pre-eclampsia
Thrombophilic defects
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12
Q

What are the maternal behavioural factors linked to IUGR, SGA?

A 
Smoking
Low booking weight (<50kg)
Poor nutrition
Age <16/ >35 at delivery
Alcohol
Drugs
High altitude
Social deprivation
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13
Q

What are the fetal factors linked to IUGR, SGA?

A 
Multiple pregnancy
Structural abnormality
Chromosomal abnormalities
Intrauterine (congenital) infection
Inborn errors of metabolism
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14
Q

What are the placental factors linked to IUGR, SGA?

A 
Impaired trophoblast invasion
Partial abruption or infarction
Chorioamnionitis
Placental cysts
Placenta praevia
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15
Q

When is the period of placentation?

A

10-12 weeks

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16
Q

What is the definition of pre-eclampsia?

A

Multisystem disease that usually manifests as hypertension and proteinuria

  • Gestational hypertension of at least 140/90 mmHg on 2 separate occasions >4hrs apart
  • Proteinuria >0.3g/day (PCR>30)
  • arising de novo after the 20th week of gestation in a previously normotensive woman and resolving completely by 6th postpartum week
17
Q

Which foetuses would require growth monitoring?

Indication: Bad obstetric history

A 
- Bad obstetric history
Previous maternal hypertension
Previous FGR
Stillbirth
Placental abruption
18
Q

Which foetuses would require growth monitoring?

Indication: Concerns in index pregnancy

A

Abnormal serum biochemistry (PAPP-A<0.3 MoM)
Reduced symphysis fundal height
Maternal systemic disease (e.g. hypertension, renal, coagulation, PET)
Antepartum haemorrhage
Multiple pregnancy

19
Q

What maternal history would predispose to FGR?

A 
Poor obstetric history
Primips
Obese
Afro-carribean/ African
Strong family history
Essential hypertension
Diabetes
Systemic vascular disease
Renal disease
Thrombophilias
20
Q

Describe how screening of “at risk” pregnancies at 24 weeks is done?

A

Uterine artery Doppler during 1st/2nd trimester

Identify high resistance flow

21
Q

What is the sequence of events in FGR?

A

i. Increased Uterine Artery PI
ii. Increased Umbilical artery PI (reduced liquor volume)
iii. Decreased Middle Cerebral Artery PI (reduced Fetal movement)
iv. Increased Ductus Venosus PI
v. IUD

22
Q

What is Pulsatility Index?

A

Pulsatility index is another parameter used to assess pulsatility and is defined as the difference between maximum and minimum blood flow velocity, normalized to the average velocity.

23
Q

When using Doppler US, when does increased impedence in umbilical arteries become evident?

A

When at least 60% of placental vascular bed is obliterated

24
Q

Where is the cardiac output in foetus redistributed to under hypoxia?

A 
Increased flow:
- Brain
- Heart
- Adrenals
Decreased flow:
- Lungs
- Kidneys
- Gut
25
Q

What are the CNS effects on foetus during hypoxia?

A
  • Poor tone
  • Altered breathing
  • Altered movement patterns
  • Changes in heart rate patterns
26
Q

When 60-70% of placental vascular tree is not functioning, what follows?

A

Decrease in impedance to blood flow in the middle cerebral artery as a consequence of “brain sparing effect”, while resistance increases in aortic blood flow.
The redistribution of the blood flow allows preferential oxygenation of fetal vital organs

27
Q

What are the 3 shunts in fetal circulatory system?

A
  1. Ductus venosus (shunts oxygenated blood from placenta away from semifunctional liver and towards the heart)
  2. Foramen Ovale (shunt between atriums)
  3. Ductus arteriosus (aorta and pulmonary artery, shunt blood away from lungs)
28
Q

Which ventricle is dominant in fetal?

A

Right ventricle

29
Q

What is used to quantitatively assess fetal movement countings?

A

Cardiff kick chart (UK)

Mothers record the time taken each day to feel 10 fetal movements

30
Q

What should be done if a reduction in fetal movements is reported?

A

Cardiotocography (CTG)

Ultrasound assessment

31
Q

What are the 3 general principles of management of FGR pregnancies?

a. Problems in index preganacy
b. Screening of “at risk” pregnancies
c. Delivery

A

a. Manage according to serial fetal biometry, fetal Doppler, Biophysical profile and CTG
b. 24/40 wks Ut A screening
c. Aim to deliver when >28 weeks and/or >500g
Caesarean section for compromised foetuses

32
Q

What can be administered to mother at gestations <36 weeks in order to improve neonatal wellbeing?

A

Corticosteroids

33
Q

Is preeclampsia highly correlated to early or late IUGR?

A

Early

34
Q

Is early or late IUGR more common?

A

Late

Y2 LCRS 1 - RDA (9 decks)

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