Large/Small for Gestational Age Flashcards
define large for gestational age
> 90th percentile of estimated foetal weight
LGA also known as
macrosomia
birth weight of a baby considered large for gestational age
> 4.5kg at birth
other than constitutional, give some reasons that a foetus may be large for gestational age
maternal diabetes
maternal obesity
maternal rapid weight gain
previous macrosomal baby
overdue
6 risks to the mother as a result of macrosomia
shoulder dystosia
failure to progress
perineal tears
uterine rupture (rare)
necessity of instrumental delivery
PPH
4 complications to the child as a result of macrosomia (2 immediate and 2 long term)
increased risk of birth complication e.g. Erb’s palsy
neonatal hypoglycaemia (due to raised insulin?)
obesity
T2DM
other than macrosomia, what else will cause a larger than normal uterus?
polyhydramnios
multiple pregnancy
mothers with macrosomal babies should be investigated for
polyhydramnios
multiple pregnancy
true or false: the vast majority of LGA babies will have complicated births
what is the implication of this?
false; most LGA babies will have a normal vaginal delivery
NICE does not recommend induction of labour on the grounds of macrosomia alone
main risk of vaginal delivery with a LGA baby
shoulder dystocia
define SGA
below the 10th centile for their gestational age
how is foetal size estimated? (2)
USS can be used to determine:
estimated foetal weight
abdominal circumference
suggest 4 factors which need to be taken into account when considering if a foetus is SGA (4 maternal factors)
ethnicity
weight
height
parity
define severe SGA
below the third centile
define low birth weight
<2500 g
2 broad causes of SGA
constitutionally small (matching the mother/the family; normal growth velocity)
IUGR
2 broad causes of IUGR
placental problems e.g. pre-eclampsia, maternal anaemia
foetal problems e.g. chromosomal abnormalities, foetal infections
4 indications of IUGR as opposed to constitutionally small
reduced foetal movements
abnormal CTGs
reduced amniotic fluid volume (basically means oliguria)
abnormal doppler studies
4 short term complications of SGA
foetal death
birth asphyxia
neonatal hypothermia
neonatal hypoglycaemia
4 long term complications of SGA
cardiovascular disease
mood disorders
T2DM
obesity
which serum marker can indicate that a foetus is SGA?
PAPPA (low PAPPA = small foetus)
which extreme of age is more likely to have a SGA foetus?
older mothers
which extreme of age is more likely to have a SGA foetus?
older mothers
when are pregnant patients assessed for their risk of having a SGA baby?
at the booking clinic
how are patients who are considered low risk of having a SGA foetus monitored for IUGR?
with serial symphysis fundal height measurements
if these are abnormal then proceed to serial growth scans
how are patients who are considered high risk of having a SGA foetus monitored for IUGR?
serial growth scans
in addition to foetal weight and abdominal circumference, what else is taken at the time of a serial growth scan? (2)
umbilical artery doppler
amniotic fluid volume
3 reasons to use serial growth scans over symphysis/fundal height
1 major risk factor
3 minor risk factors
difficult to measure SFH (BMI >35, large fibroids)
suggest the management of static growth
early delivery
suggest the management of abnormal doppler results
early delivery (remove the foetus from the hostile uterus)
which drugs are given when delivery is planned early?
is this still true for cesaerean?
corticosteroids
yes - it is especially the case for caesarean
