Perinatal medicine

Question 1

What is the definition of small for gestational age

Answer 1

Babies with a birthweight below the 10th centile for their gestation

Question 2

What is the definition of large for gestational age

Answer 2

Babies with a birthweight above the 90th centile for their gestation

Question 3

What are the 2 patterns of growth restriction

Answer 3

Asymmetrical: weight or abdominal circumference lies on a lower centile than that of the head
Symmetrical: head circumference is equally reduced.

Question 4

When does asymmetrical growth occur

Answer 4

When placenta fails to provide adequate nutrition late in pregnancy but brain growth is relatively spared. Can be secondary to pre eclampsia, multiple pregnancy, maternal smoking or idiopathic.

Question 5

What does symmetrical growth suggest

Answer 5

Suggests prolonged period of poor growth starting in early pregnancy. Usually due to a constitutionally small but healthy fetus. May be due to a fetal chromosome disorder, congenital infection, maternal drug/alcohol misuse, malnutrition

Question 6

Signs of growth-restricted fetus antenatally

Answer 6

• reduced growth in femur length + abdominal circumference.
• abnormal umbilical artery doppler
• Oligohydramnios
• Reduced fetal movements and CTG

Question 7

After birth, what 4 things are growth restricted infants liable to

Answer 7

hypothermia, hypoglycaemia, hypocalcaemia, polycytheamia (due to hypoxia)

Question 8

What 2 things is a macrosomnic baby usually a feature of?

Answer 8

GDM, congenital syndrome

Question 9

Problems associated with LGA

Answer 9

asphyxia during delivery, breathing difficulty from enlarged tongue, birth trauma, hypoglycaemia (GDM), polycythaemia

Question 10

What are the main sutures and fontanelle?

Answer 10

CLAMPS: Coronal suture, lamboid suture, anterior fontanelle, metopic suture, posterior fontanelle, sagittal suture.

Question 11

During a NIPE, what does a tense bulging fontanelle indicate and what does a sunken fontanelle indicate?

Answer 11

Tense bulging = raised ICP (hydrocephalus, illness, meningitis)
Sunken = dehydration

Question 12

During a NIPE examination, a red reflex is not seen. Potential causes?

Answer 12

Cataracts, retinoblastoma, corneal opacity

Question 13

What are risk factors for developmental dysplasia of the hip?

Answer 13

positive family history, female, breech presentation, neuromuscular disorder of infant.

Question 14

What manoeuvres are used for DDH

Answer 14

Barlow: hip is flexed and adducted. Femoral head gently pushed downwards.
Ortolani: hip is relocated back into acetabulum with a clunk.

Question 15

Why is vitamin K given and how is it usually administered?

Answer 15

Increase clotting and prevent hemmorhage. Infant formula milk has a higher vitamin K content than breast milk.

Question 16

What is subconjunctival hemmorhage?

Answer 16

burst blood vessel in white of the eye. Occurs during delivery. Resolve spontaneously.

Question 17

What is erythema toxicum (neonatal urticaria)

Answer 17

Common rash appearing at 2-3 days of age. May have white pinpoint papules (small bumps) at centre or just Red flat patches. Resolve spontaneously.

Question 18

What are Mongolian blue spots

Answer 18

Blue/black macular discoloration at base of spine and on buttocks. Usually in AfroCarribean or Asian. Fade slowly over first few years.

Question 19

What is difference between positional talipes and structural talipes equinovarus?

Answer 19

• Positional talipes = ankles suppinated and rolled inwards. Muscles tight but bones unaffected. Foot can be fully dorsiflexed to touch the front of lower leg + still moved into normal position. Physio + self-resolving
• Structural = bones affected. Foot is fixed and cannot be corrected completely. Affected foot shorter. Orthapaedic surgeon referral. Cant be dorsiflexed.

Question 20

What is a port wine stain? What happens to it? What is the rare condition associated?

Answer 20

Port wine stains are pink patches of skin, often on the face, caused by abnormalities affecting the capillaries. Don’t fade with time and typically turn a darker red or purple colour. Rarely, associated to a condition called Sturge-Weber syndrome, where there can be visual impairment, learning difficulties, headaches, epilepsy and glaucoma.

Question 21

What is a strawberry naevus/haemangioma

Answer 21

Collection of small blood vessels that form a lump under the skin.
Near the eyes, mouth or affecting the airway may require beta blockers (i.e. propranolol). Otherwise they can be monitored and usually resolve with time.