Large/Small for Gestational Age Flashcards

1
Q

define large for gestational age

A

> 90th percentile of estimated foetal weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

LGA also known as

A

macrosomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

birth weight of a baby considered large for gestational age

A

> 4.5kg at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

other than constitutional, give some reasons that a foetus may be large for gestational age

A

maternal diabetes

maternal obesity

maternal rapid weight gain

previous macrosomal baby

overdue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

6 risks to the mother as a result of macrosomia

A

shoulder dystosia

failure to progress

perineal tears

uterine rupture (rare)

necessity of instrumental delivery

PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

4 complications to the child as a result of macrosomia (2 immediate and 2 long term)

A

increased risk of birth complication e.g. Erb’s palsy

neonatal hypoglycaemia (due to raised insulin?)

obesity

T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

other than macrosomia, what else will cause a larger than normal uterus?

A

polyhydramnios

multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

mothers with macrosomal babies should be investigated for

A

polyhydramnios

multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

true or false: the vast majority of LGA babies will have complicated births

what is the implication of this?

A

false; most LGA babies will have a normal vaginal delivery

NICE does not recommend induction of labour on the grounds of macrosomia alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

main risk of vaginal delivery with a LGA baby

A

shoulder dystocia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

define SGA

A

below the 10th centile for their gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how is foetal size estimated? (2)

A

USS can be used to determine:

estimated foetal weight

abdominal circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

suggest 4 factors which need to be taken into account when considering if a foetus is SGA (4 maternal factors)

A

ethnicity

weight

height

parity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

define severe SGA

A

below the third centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

define low birth weight

A

<2500 g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

2 broad causes of SGA

A

constitutionally small (matching the mother/the family; normal growth velocity)

IUGR

17
Q

2 broad causes of IUGR

A

placental problems e.g. pre-eclampsia, maternal anaemia

foetal problems e.g. chromosomal abnormalities, foetal infections

18
Q

4 indications of IUGR as opposed to constitutionally small

A

reduced foetal movements

abnormal CTGs

reduced amniotic fluid volume (basically means oliguria)

abnormal doppler studies

19
Q

4 short term complications of SGA

A

foetal death

birth asphyxia

neonatal hypothermia

neonatal hypoglycaemia

20
Q

4 long term complications of SGA

A

cardiovascular disease

mood disorders

T2DM

obesity

21
Q

which serum marker can indicate that a foetus is SGA?

A

PAPPA (low PAPPA = small foetus)

22
Q

which extreme of age is more likely to have a SGA foetus?

A

older mothers

23
Q

which extreme of age is more likely to have a SGA foetus?

A

older mothers

24
Q

when are pregnant patients assessed for their risk of having a SGA baby?

A

at the booking clinic

25
Q

how are patients who are considered low risk of having a SGA foetus monitored for IUGR?

A

with serial symphysis fundal height measurements

if these are abnormal then proceed to serial growth scans

26
Q

how are patients who are considered high risk of having a SGA foetus monitored for IUGR?

A

serial growth scans

27
Q

in addition to foetal weight and abdominal circumference, what else is taken at the time of a serial growth scan? (2)

A

umbilical artery doppler

amniotic fluid volume

28
Q

3 reasons to use serial growth scans over symphysis/fundal height

A

1 major risk factor

3 minor risk factors

difficult to measure SFH (BMI >35, large fibroids)

29
Q

suggest the management of static growth

A

early delivery

30
Q

suggest the management of abnormal doppler results

A

early delivery (remove the foetus from the hostile uterus)

31
Q

which drugs are given when delivery is planned early?

is this still true for cesaerean?

A

corticosteroids

yes - it is especially the case for caesarean