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Appreciating Complex Midwifery Care > IUGR and IUD > Flashcards

IUGR and IUD Flashcards

1
Q

What is SGA?

A

Small for Gestational Age - estimated foetal weight or abdominal circumference is <10th centile

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2
Q

What is IUGR?

A

Intrauterine Growth Restriction - a slower than normal rate of foetal growth

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3
Q

What is the general weight of an IUGR baby?

A

<2500g or <10th centile

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4
Q

What is an IUD?

A

Intrauterine Death - death of a foetus at any stage in pregnancy after the 1st trimester and before the onset of labour

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5
Q

What is a late foetal loss?

A

A baby born between 22+0 and 23+6 weeks, showing no signs of life irrespective of when death occurred

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6
Q

What is a stillbirth?

A

A baby born at/ after the 24+0 weeks showing no signs of life, irrespective of when death occurred

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7
Q

What is a miscarriage?

A

The loss of a pregnancy in the first 22 weeks

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8
Q

What is a neonatal death?

A

A live born baby (born at 20+0 week or later or with a BW >400g) who died before 28 completed days after birth

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9
Q

What is a perinatal death?

A

Stillbirths and neonatal deaths in the 1st week of life

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10
Q

What are some extrinsic factors that cause IUGR?

A
  • Maternal nutritional imbalance
  • Hazardous substance exposure
  • Drugs/ Smoking/ Alcohol
  • Domestic abuse
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11
Q

What are the 2 types of IUGR?

A

Symmetrical and Asymmetrical

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12
Q

What are the risks associated with symmetrical IUGR?

A
  • Stillbirth
  • Chromosomal abnormality
  • Infection
  • Reduced intellect
  • Short stature
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13
Q

What are the risks associated with asymmetrical IUGR?

A
  • Stillbirth
  • MAS
  • Perinatal asphyxia
  • Hypoglycaemia/ Hypothermia/ Hypocalcaemia
  • NEC
  • Pulmonary haemorrhage
  • Prematurity
  • Oligohydramnios
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14
Q

Give statistics for the effect of SGA on mortality rates

A

SGA is linked to >50% of stillbirths and 42% of early neonatal deaths

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15
Q

What is the purpose of a Doppler ultrasound?

A

Uses sound waves to detect the movement in blood vessels, in order to study blood circulation in the baby, uterus and placenta

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16
Q

What did the Cochrane review find about Dopplers?

A
  • Doppler of the umbilical artery may decrease the number of babies who die and lead to fewer CS and IOL
  • No difference in number of stillbirths, instrumental deliveries or babies with low APGAR 5 mins after birth
  • In babies with IUGR, long-term developmental outcome was improved when decision to deliver was based on late ductus venous changes/ abnormal CTG
17
Q

What happens to the umbilical artery doppler at 24-30 weeks?

A

Foetus can have absent End-Diastolic Flow for several weeks

If this occurs in early gestation, it is not a sole indication for delivery

18
Q

What should the decision for delivery be based on for an IUGR baby at 30-34 weeks?

A
  • Amniotic fluid
  • Movements
  • CTG
  • Uterine Artery Doppler
19
Q

What is a concern in an IUGR baby after 34 weeks?

A

Abnormal UAD is unusual, suggesting severe feto-placental pathology = deliver asap

20
Q

Describe how foetal movements can indicate mortality

A
  • Foetal death may be preceded by a day or more of RFM
  • Occasionally extreme activity precedes foetal death
  • 2 RCTs failed to show that routine recording of FM reduced the incidence of IUD
21
Q

What are the 4 steps of the Saving Babies Lives Care Bundle?

A
  1. Reducing smoking in pregnancy
  2. Risk assessment and surveillance for foetal growth restriction
  3. Raising awareness of RFM
  4. Effective foetal monitoring during labour
22
Q

What indications of IUD are there related to the mother?

A
  • Reduced/ absent FM
  • PV bleeding
  • Abdominal pain
  • Premature labour
  • Offensive discharge
  • A feeling that ‘something is wrong’
23
Q

What indications of IUD are there that the midwife may pick up?

A
  • No change in fundal height
  • SGA
  • Rigid, painful abdomen that’s difficult to palpate
  • Unable to auscultate FHR
24
Q

How should IUD be diagnosed?

A
  • Must be confirmed by USS by a qualified and experienced sonographer
  • Delay in delivert of IUD can increase risk of APH
25
Q

What are some maternal causes of perinatal death?

A
  • Infection
  • Cord problems (cord prolapse, true knot)
  • Placental separation
  • Intrauterine hypoxia
  • Placental insufficiency/ failure (PIH, post-maturity, diabetes)
26
Q

What are some foetal causes of perinatal death?

A
  • Prematurity
  • RDS
  • Birth trauma
  • MAS
  • Intraventricular haemorrhage
  • Failed resuscitation
  • Twin-to-twin transfusion
  • Rh disease
27
Q

According to the MBRRACE report, what is the quality of care grading for babies?

A

Good care = 21%
Improvements could have been made but would have made no difference = 19%
Improvements could have been made that would have made a life-saving difference = 60%

Appreciating Complex Midwifery Care (14 decks)

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