PBL 2

Question 1

Symphysis-fundal height Definition

Answer 1

distance between the pubic symphysis and the fundus

Question 2

when is a baby deemed to be small

Answer 2

A baby is deemed to be “small-for-gestational age” at birth if it weighs less than the tenth percentile for the appropriate gestation

Question 3

what are the causes of intrauterine growth restriction

Answer 3

In most cases the cause is unknown, and may simply represent the lower end of the normal range.

Specific Causes
• Pre-eclampsia.
• Congenital or chromosomal abnormalities.
• Infections (e.g. rubella, cytomegalovirus, toxoplasmosis, syphilis)
• “Placental insufficiency”.
o Minor disturbance of placentation in early pregnancy.

Question 4

what are the risk factors in the mother that can lead to intrauterine growth restriction

Answer 4

• Alcohol abuse.
• Clotting disorders
• Drug Addiction
• High Blood Pressure or Heart Disease
• Kidney Disease
• Poor Nutrition.

Question 5

what does intrauterine growth restriction increase the risk of

Answer 5

• Intrapartum fetal distress.
• Intrapartum asphyxia (hypoxia)
• Postnatal hypoglycaemia.
• Impaired neurodevelopment.
• Intrauterine death.
• (Possible) type 2 diabetes and hypertension in adult life.

Question 6

How do you assess the fundal height

Answer 6

• Distance from the pubic bone (symphysis pubis) to the top of the uterus (fundus) (+- 2m).
o Symphysio-fundal height.

Question 7

what does the fundal heigh correspond to

Answer 7

corresponds to gestational age in weeks

Question 8

what is the negative of a fundal height

Answer 8

• Directly not an accurate measure of fetal growth.

o Gives a crude estimate only in serial measurements.

Question 9

what does ultrasound measure

Answer 9

• Estimates of fetal weight in utero (and therefore production in birth weight)

Question 10

what measurements is the fetal weight in ultrasound derived from

Answer 10

o Biparietal diameter (BPD)
o Head circumference (HC)
o Trans-abdominal circumference (AC).
o Femur Length (FL).

Question 11

what is the percentage error in ultrasound measurements and assessment of fundal height

Answer 11

• The error of each of these estimates is 16% (2SD) if gestation is known.

Question 12

what are estimates of sensitivity of ultrasound

Answer 12

• Estimates of sensitivity (ability to determine case directly) of ultrasound in respect to growth retardation (birthweight less than 10th percentile) range from 40% to 80%.
o There is a high incidence of false positive results.

Question 13

what are the two types of intrauterine growth restriction for BPD

Answer 13

Sudden Deviation from previously normal pattern.

Parallel but Lower: growth at lower range than value

Question 14

what is a better measurement than BPD

Answer 14

A better index is the HC and AC.

Question 15

what are the two types of intrauterine growth restriction using HC and AC

Answer 15

Symmetrical IGUR

Asymmetrical IGUR

Question 16

describe symmetrical IUGR

Answer 16

Symmetrical IUGR: where both the HC and AC.

• Maintaining a ratio HC: AC of 1.

Question 17

what are the causes of symmetrical IUGR

Answer 17

• Racial programming
• Congenital abnormalities such as karyotype problems
• Early pregnancy damage (due to infections/toxins).

Question 18

describe asymmetrical IUGR

Answer 18

• Brain growth (HC) is preserved at the expense of the liver (AC).
• Ratio HC:AC less or equal to one.

Question 19

What are the causes of asymmetrical IUGR

Answer 19

• Placental Insufficiency  chronic hypoxia.
o Pre-eclampsia
o Smokers
o Diabetes

Question 20

what are the other tests that you can carry out

Answer 20

• Fetal movements.
• Antepartum cardiotocogarphy (CTG)
• Measurement of amniotic fluid volume.
• Measurement of fetal breathing movements.
• Doppler blood-flow studies of umbilical and fetal cerebral arteries.

Question 21

How do you manage a growth restricted baby

Answer 21

• Intensification of existing antenatal care (including serial repetition of various tests).
- can early deliver in serious cases

Question 22

How is early delivery done

Answer 22

• Done through induction or C-section.

* Course of glucocorticoid injections given to mother at least 24 hours before delivery.

Question 23

what is the benefits of early delivery

Answer 23

o Improves fetal outcome/reduce perinatal complications of prematurity.
o Enhances fetal lung maturity (stimulates surfactant production)
o Protects fetus from intracranial haemorrhages
o Protects from necrotizing enterocolitis.

Question 24

what happens in an extremely low birth weight

Answer 24

Extremely low birth weight = high risk of perinatal mortality and neonatal morbidity.
• Possible increased CAD, hypertension and type 2 diabetes later in life (Barker Hypothesis).

Question 25

what negatives does a short gestational age have in the long term

Answer 25

= greater impact on long-term neurological outcome.

Question 26

what is preeclampsia

Answer 26

• Appearance of hypertension (systolic >140) and proteinuria (from ~20 weeks).

Question 27

How many people are affected by pre-eclampsia

Answer 27

Pregnancy disorder that affects 3%-5% of all pregnancies.

Question 28

when does pre-eclampsia occur

Answer 28

Most cases occur in the third trimester (after 24-26 weeks)

Question 29

what are the weeks defining each trimester

Answer 29

First Trimester: week 1 to week 12.
Second Trimester: week 13 to week 27.
Third Trimester: week 28 to birth.

Question 30

what causes pre-eclampsia

Answer 30

Caused by problems of placental development:
•	Trophoblast proliferation
•	Differentiation
•	Invasion
•	Angiogenesis 

Believed to be because of abnormal maternal adaptation to trophoblast of fetus.

Question 31

what are the symptoms of a pre-eclampsia

Answer 31

• Oedema (feet, ankles, face and hands)
• Severe headaches
• Visual problems
• Vomiting

Question 32

How do you manage a Pre-elcamspia

Answer 32

• Objective is to keep the baby utero for if possible.
• Mother and baby are closely monitored until the delivery can take place ~ 37 to 38th week.

If condition worsens before 37 weeks and there are serious concerns  delivery of baby.