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Human Development > PBL 2: Poor Intrauterine Growth > Flashcards

PBL 2: Poor Intrauterine Growth Flashcards

1
Q

What is Intrauterine Growth Restriction?

A

• Small for gestational age (SGA) = <10th centile for gestation

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2
Q

What is low birth weight?

A

<2,500g at any gestational age.

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3
Q

Why does IUGR occur?

A

blood or nutrient supply to the foetus is not sufficient

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4
Q

Risk factors of IUGR?

A
  • Alcoholism.
  • Clotting disorders.
  • Drug addiction.
  • Hypertension or heart disease.
  • Kidney disease.
  • Poor nutrition.
  • Smoking.
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5
Q

3 types of causes of IUGR?

A

Foetal
Maternal
Placental

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6
Q

Foetal causes of IUGR?

A
  • Chromosomal disorders (trisomy 18 = Edwards syndrome).
  • Structural malformations.
  • Congenital infections (CMV, rubella, syphilis).
  • Normal!
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7
Q

Maternal causes of IUGR?

A
  • Undernutrition (low BMI).
  • Maternal hypoxia (heart disease).
  • Drugs.
  • Infection (TB, malaria).
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8
Q

Placental causes of IUGR?

A
  • Reduced vascular supply (pre-eclampsia, hypertension, diabetes).
  • Placental thrombosis.
  • Twin-twin transfusion syndrome (Monochorionic).
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9
Q

Investigations into IUGR?

A
  • Symphysis fundal height.
  • Ultrasound.
  • Foetal movement assessments.
  • Cardiotocography (TCG).
  • Amniotic fluid volume.
  • Doppler blood-flow studies.
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10
Q

What is symphysis fundal height?

A

• Distance in cm (+/-2) from the symphysis pubis and the fundus corresponds to the gestational week roughly.

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11
Q

When is symphysis fundal height done from?

A

24 weeks

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12
Q

Doppler ultrasound for umbilical artery?

A
  • Blood flowing through the umbilical arteries is coming from the foetus to the placenta.
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13
Q

What happens to umbilical artery in IUGR?

A

Increased umbilical artery resistance

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14
Q

what is normal for MCA?

A

little flow during diastole

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15
Q

What happens to MCA in IUGR?

A
  • Increased resistance due to IUGR will increase flow during diastole
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16
Q

What is most reliable way of measuring foetal growth?

A

Ultrasonography

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17
Q

How does ultrasonography work?

A

Foetal growth corresponds to foetal weight

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18
Q

What is issue with ultrasonography?

A

• Only issue is high incidence of false-positive results.

19
Q

What does US measure?-

A
  • Biparietal Diameter (BPD).
  • Head circumference (HC).
  • Transabdominal circumference (AC).
  • Femur length.
20
Q

Classification of IUGR?

A

Symmetrical

Asymmetrical

21
Q

Is symmetrical or asymmetrical more common?

A

Asymmetrical

22
Q

what happens in symmetrical?

A
  • Head circumference and transabdominal circumference both low.
  • HC:AC = 1.
23
Q

What happens in assymmetrical?

A
  • The head is spared in the expense of the liver.

- HC:AC >1.

24
Q

What does symmetrical indicate?

A
  • Indicates earlier cause for IUGR; congenital or infection.
25
Q

What does asymmetrical indicate?

A
  • Indicates later cause for IUGR due to placental insufficiency of oxygen (pre-eclampsia or diabetes).
26
Q

Management for IUGR?

A
  • Intensify existing antenatal care.
  • If the foetus becomes compromised induce labour or perform a C section.
  • A glucocorticoid injection is given at least 24 hours prior to delivery to reduce the effects of prematurity.
27
Q

What does glucocorticoids do?

A
  • Stimulates surfactant production by type 2 pneumocytes to enhance foetal lung.
  • Protect the foetus from intracranial haemorrhage and necrotizing enterocolitis.
28
Q

Neonatal IUGR complications?

A
  • Perinatal hypoxia.
  • Respiratory distress.
  • Hypothermia.
  • Intrauterine death.
  • Increased risk of infection.
  • Prematurity.
29
Q

What is barker hypothesis?

A
  • IUGR is associated with later in life diseases.
  • Hypertension, T2D and CVD are all increased.
  • There is also an increased risk of neurological damage like cerebral palsy.
30
Q

When does pre-eclampsia appear?

A

20 weeks gestation

31
Q

What characterises pre-eclampsia?

A
  • Hypertension.
  • Proteinuria may be present.
  • Oedema may be present.
32
Q

Cause of pre-eclampsia?

A
  • Pre-eclampsia is caused by failure of the trophoblasts to proliferate and invade.
  • The spiral arteries become fibrous and are too narrow for proper blood supply.
33
Q

Pathophysiology of pre-eclampsia?

A
  • The placenta does not receive adequate perfusion and so releases inflammatory proteins.
  • These cause endothelial cell dysfunction.
34
Q

Why is there oedema in pre-eclampsia?

A

• Endothelial cell dysfunction increases vascular permeability

35
Q

Why is there proteinuria in pre-eclampsia?

A

• Lack of perfusion also causes glomerular damage

36
Q

Why is there hypertension in pre-eclampsia?

A

• There is vasoconstriction and the kidneys retain more salt

37
Q

Risk factors for pre-eclampsia?

A
  • > 40.
  • Multiple pregnancy.
  • Obesity.
  • Nullparity (never given birth).
  • Diabetes.
  • Family history.
  • Previous pre-eclampsia.
38
Q

Management of pre-eclampsia?

A
  • Women who are at high risk of pre-eclampsia should take 75mg of aspirin from the 12th week until full term.
  • Labetalol is an oral anti-hypertensive which can be used.
39
Q

When does monitor of pre-eclampsia last until?

A

37/38 weeks

40
Q

What happens if condition worsens before 37th week (pre-eclampsia)?

A

Early delivery

41
Q

Complications of pre-eclampsia?

A

Eclampsia

HELLP syndrome

42
Q

What is HELLP?

A 
H = haemolysis
EL = elevated liver enzymes
LP = low platelets
43
Q

What is eclampsia?

A
  • Onset of seizures in pregnant women with pre-eclampsia.

- Caused by cerebral oedema.

44
Q

How to treat eclampsia?

A

Magnesium sulphate

Human Development (8 decks)

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