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Year 2 RE > Placenta And Intra-uterine Growth Restriction > Flashcards

Placenta And Intra-uterine Growth Restriction Flashcards

1
Q

What is foetal growth restriction?

A
  • failure of the foetus to achieve its predetermined growth potential
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2
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential. What is the primary reason for this?

A
  • placenta dysfunction
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3
Q

What is small for gestational age (SGA)?

A
  • term used to describe a baby who is smaller than the usual amount for the number of weeks of pregnancy
  • BUT not foetal growth restriction
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4
Q

Small for gestational age (SGA) is a term used to describe a baby who is smaller than the usual amount for the number of weeks of pregnancy, generally those in the <10 centile. What are the 2 methods commonly used to assess if the baby is SGA?

A
  • estimated foetal weight

- abdominal circumference

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5
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. What are the 2 types of FGR?

A

1 - symmetrical

2 - asymmetrical

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6
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. There are 2 types of FGR, symmetrical and asymmetrical. What is symmetrical and asymmetrical FGR?

A
  • symmetrical = small head and small abdomen (BUT everything is symmetrical)
  • asymmetrical = normal head and small abdomen (NOT symmetrical)
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7
Q

What 3 measures are used to determine if foetal growth restriction (FGR) is present?

A

1 - size
2 - growth
3 - type

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8
Q

Assessing the size of the baby in pregnancy is crucial to assess if the baby has a small gestational age (SGA). What is the definition from the WHO on if a baby is SGA?

A
  • <2500 grams or 2.5kg at birth
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9
Q

When assessing the growth of a foetus during pregnancy, why is it important to perform multiple observations?

A
  • a dynamic and changing process
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10
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. There are 2 types of FGR, symmetrical and asymmetrical:

  • symmetrical = small head and small abdomen (BUT everything is symmetrical)
  • asymmetrical = normal head and small abdomen (NOT symmetrical)

What are the 3 most common causes for symmetrical FGR?

A

1 - congenital/chromosomal abnormalities
2 - intrauterine infections
3 - environmental factors

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11
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. There are 2 types of FGR, symmetrical and asymmetrical:

  • symmetrical = small head and small abdomen (BUT everything is symmetrical)
  • asymmetrical = normal head and small abdomen (NOT symmetrical)

What is common causes for asymmetrical FGR?

A
  • pathology associated with pregnancy (delayed onset)

- pre-eclampsia (high BP and coagulation issues), essential hypertension

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12
Q

What are some of the risk factors associated with an increased risk of small gestational age?

A
  • asian/Indian ethnicity
  • low BMI and maternal weight gain
  • nulliparity (1st pregnancy)
  • daily vigorous exercise
  • maternal exposure to caffeine
  • one baby at one time
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13
Q

A woman attends her GP for pre-conception counselling because the first child was born small for gestational age (SGA). What intervention is significant in reducing risk of SGA foetus in those with risk factors?

1 - Progesterone
2 - Dietary modification
3 - Calcium supplements
4 - Smoking cessation
5 - Anti platelets
A

4 - Smoking cessation

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14
Q

In non-pregnant women there are a number of different blood vessels that supply the uterus. However, once the placenta has formed, angiogenesis begins and 3 types of arteries develop within the placenta. What are these 3 blood vessels called?

A

1 - arcuate arteries
2 - uterine arteries
3 - spiral arteries

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15
Q

What cell that is derived from the blastocyst forms the placenta?

A
  • trophoblasts
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16
Q

What is the most common finding in stillborn babies?

A
  • foetal growth restriction
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17
Q

If a baby is born and has foetal growth restrictions what are some of the acute conditions they may develop?

A
  • necrotising enterocolitis
  • low apgar scores (score based on vitals)
  • hypoxic brain injury
  • respiratory support
  • chronic lung disease
  • retinopathy
  • prolonged neonatal intensive care unit
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18
Q

If a baby is born and has foetal growth restrictions what are some of the chronic conditions they may develop?

A
  • metabolic electrolyte imbalance
  • failure to thrive
  • learning difficulties
  • short stature
  • cerebral palsy
  • mental handicap
19
Q

What condition is evident from the data in the figure below?

A
  • baby with foetal growth restriction (FGR)
20
Q

The data in the figure below demonstrates a baby with foetal growth restriction (FGR). What imaging would have provided the measurements presented here?

A
  • serial ultrasound scans
21
Q

What is the gold standard for antenatal care that is used to identify foetal growth restriction?

A
  • serial ultrasound with doppler scans
22
Q

Abdominal palpation can be used to identify the foetal size to identify if the foetus is at risk of foetal growth restriction. What is the detection rate of this method?

A
  • 30%

- can be difficult in early and late pregnancy

23
Q

A measurement from the symphysis to the fundus, provides fundal height with abdominal girth. What are the detection rates for this in detecting foetal growth restriction?

A
  • 20-80% detection rate

- does not improve perinatal outcome

24
Q

What imaging modalities are currently used to try and detect foetal growth restriction?

A
  • serial ultrasound (amniotic fluid volume) (poor predictive value)
  • serial ultrasound with doppler imaging (gold standard)
  • umbilical dopplers (poor predictive value)
25
Q

Cardiotocography (CTG) is a technique that can be used to detect if a foetus is at risk of foetal growth restriction. What is CTG?

A
  • instrument that can detect foetal HR and uterine contractions
26
Q

When assessing foetal well being, in addition to imaging modalities, we can determine the foetus biophysical profile. What 5 measurements are included in this profile?

A
  • cardiotocography (HR and uterine contractions)
  • foetal breathing movements (ultrasound)
  • foetal body movements (ultrasound)
  • liquor volume (amniotic fluid volume)
  • foetal growth
27
Q

When assessing foetal well being, in addition to imaging modalities, we can determine the foetus biophysical profile. The following 5 measurements are included in this profile:

  • cardiotocography (HR and uterine contractions)
  • foetal breathing movements (ultrasound)
  • foetal body movements (ultrasound)
  • liquor volume (amniotic fluid volume)
  • foetal growth

What is the purpose of utilising the biophysical profile in relation to foetal growth restriction (FGR)?

A
  • identify foetus at risk of FGR and therefore hypoxia

- rule out just small babies without FGR

28
Q

How can the diagnosis of a foetus that is at risk of foetal growth restriction be optimised?

A
  • use customised foetal growth charts

- use 2 measures of abdominal circumference and estimated foetal weight at least 3 weeks apart

29
Q

In a normal pregnancy, does the blood flowing from the mother through the umbilical cord blood vessels (umbiliical artery and vein) have any resistance?

A
  • no

- placenta acts as a sponge, from there it delivers oxygenated blood to the foetus

30
Q

What is placenta infarction?

A
  • interruption of blood supply to a part of the placenta
  • normally in the umbilical artery
  • lack of blood causes hypoxia and ischaemia
  • cells of the placenta can die
31
Q

In a pregnancy where there is placenta infarction, which is interruption of blood supply to a part of the placenta, causing its cells to die, is there a resistance to blood flow to the foetus?

A
  • placenta acts as a wall

- blood is unable to reach the foetus and reflects back along the umbilical artery

32
Q

What method can be used to detect blood flow velocity in foetal and placenta vessels?

A
  • ultrasound doppler
33
Q

When detecting blood flow velocity in foetal and placenta vessels using ultrasound doppler, what would a reduced end diastolic flow suggest?

A
  • placenta has high resistance and is failing

- baby can become hypoxic

34
Q

Does the growth chart show foetal growth restriction or small gestational age?

A
  • small gestational age

- plot is consistent and does not move between deciles

35
Q

Does the growth chart show foetal restriction growth or small gestational age?

A
  • foetal growth restriction

- begins in 9th percentile, but drop between deciles

36
Q

In the growth chart below, we can see that the top figure demonstrates a small gestational baby and the bottom chart shows a foetal growth restriction. Of the 2 which baby may need to be delivered prematurely?

A
  • foetal growth restriction

- the placenta may be failing the baby is malnourished and/or hypoxic

37
Q

In asymmetrical foetal growth restriction there is generally a larger head and/or organs compared to the abdomen, as seen in the image below. Why do some organs develop more than others?

A
  • the body adapts to lack of nutrient and hypoxia
  • for example the brain sparing effect as the foetus redistributes blood to the more critical tissues (liver, kidneys etc…)
38
Q

In the brain sparing effect that we observe in the asymmetrical foetal growth restriction, is the head circumference (HC) or abdomen circumference (AC) normally bigger?

A
  • normally head is bigger

- AC < HC

39
Q

What is Pregnancy Associated Plasma Protein-A (PAPP-A)?

A
  • a hormone that made by the placenta (afterbirth) in pregnancy
  • secreted by the placenta to maintain placenta development
40
Q

Pregnancy Associated Plasma Protein-A (PAPP-A) is a hormone that made by the placenta (afterbirth) in pregnancy secreted by the placenta to maintain placenta development. What can low levels of this indicate?

A
  • foetal growth restriction
41
Q

What do the uterine and spiral arteries provide a blood supply to?

A
  • uterine arteries = uterine

- spiral arteries = endometrium (generally lost during periods)

42
Q

What is the Barkers hypothesis?

A
  • adverse nutrition in early life including foetal growth restriction can increase risk of metabolic syndrome (obesity, diabetes, insulin insensitivity, hypertension, hyperlipidemia, coronary heart disease)
43
Q

If a baby is detected as having an abnormal blood flow to the placenta using ultrasound doppler, how many weeks should the baby be delivered?

A
  • <32 weeks

- better to be in NICU than in a uterus with restricted blood flow to the placenta

44
Q

You are counselling a 16 week gestation primiparous woman regarding her results which suggest a low PAPP-A level.Which is the only form of surveillance that, when used alone, has been shown to reduce perinatal morbidity and mortality in a high-risk population?

1 - Foetal movement monitoring
2 - USS assessment of liquor volume
3 - CTG cardiotocography
4 - Biophysical profile scoring
5 - Umbilical artery doppler
A

5 - Umbilical artery doppler

Year 2 RE (53 decks)

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