newborn

Question 1

two groups of SGA

Answer 1

1. Constitutionally small foetus
2. growth restricted foetus

Question 2

risks associated with growth restriction

Answer 2

• Stillbirth
• Birth asphyxia - which could result in Hypoxic Ischaemic Encephalopathy
• Meconium aspiration syndrome
• Meconium aspiration may take place before and during delivery
• latrogenic preterm delivery
• Neonatal complications
  Hypothermia due to reduced subcutaneous fat
• Hypoglycaemia as a result of depleted glycogen stores
• Polycythaemia due to chronic hypoxia
• Impaired neurodevelopment
  Neurological damage manifesting as cerebral palsy, seizures or minimal brain dysfunction
• Metabolic syndrome in adulthood (Barker hypothesis) - as a result of genetic imprinting due to gene selection that occurs in utero. The affected fetus has an increased risk of developing many of the metabolic factors associated with an increased risk of vascular disease in later life.
• Obesity
• Type 2 diabetes
• ## Cardiovascular disease

Question 3

complications of continued placental def in asymmetrical IUGR

Answer 3

Progressive metabolic acidosis -
- Oligohydramnios
- Loss of fetal breathing movements
- Decreased tone

° Worsening cardiac function (and metabolic state) -
- Abnormal fetal heart rate patterns
- Decreased variability
- Decelerations

AT RISK OF BIRTH ASPYREXIA

Question 4

What is the aetiology of IUGR

Answer 4

Nutrient and oxygen delivery to the placenta
- E.g. decreased oxygen carrying capacity due to maternal cyanotic heart disease, smoking, haemoglobinopathy

• Nutrient and oxygen transfer across the placenta
  Maternal vascular disease, e.g. diabetes, hypertension, autoimmune disease
• Placental damage resulting from smoking, thrombophilia, autoimmune disease
• Fetal uptake of nutrients and oxygen
• E.g. congenital abnormalities
• Fetal regulation of growth processes
• E.g. inborn errors of metabolism

Question 5

Maternal causes of IUGR

Answer 5

• Cardiorespiratory disease
• Chronic hypertension
• Pregnancy induced hypertensive disorders
• Diabetes
• Autoimmune disorders
• Thrombophilias
• Haemaglobinopathies
• Renal disease
• Malignancy
• Connective tissue disorders
• Anaemia
• Fever
• Protein energy malnutrition
• Smoking
• Drug abuse
• Alcohol

Question 6

FETAL CAUSES OF IUGR

Answer 6

• Congenital infections
• Rubella, CMV, Toxoplasmosis, Syphilis
• Structural congenital abnormalities
• Anencephaly, cardiovascular disorders, etc
• Chromosomal abnormalities
• Trisomy (13, 18, 21), Turners syndrome, etc
• Inborn errors of

Question 7

PLACENTAL CAUSES OF IUGR

Answer 7

• Twin-to-twin transfusion syndrome
• Multiple gestations
• Placenta praevia
• Recurrent antepartum haemorrhage
• Extrauterine pregnancy
• Placental abnormalities
• Circumvallate placenta, placental cysts
• Thrombosis/infarction
• Placental insufficiency - placental bed vasculopathy which is usually (but not always) associated with clinical manifestation of pre-eclampsia
• Failure of the second wave of trophoblastic invasion in the early second trimester
• Spiral arterioles do not transform into low resistance vessels
• This results in under perfusion of the choriodecidual space leading to slow fetal growth and eventual placental infarction

Question 8

What’s included in the biophysical test

Answer 8

fetal movement count
auscultation of the heart
amniotic fluid volume
doppler studies
antenatal CTG
biophysical profile

Question 9

test/investigations in IUGR

Answer 9

Biophysical test
biometric test

Question 10

what do biometric tests measure and what are the examples

Answer 10

they measure size

-SFH
Ultrasound biometry