Problems in Pregnancy: Small for Dates

Question 1

When is a birth described as pre-term?

Answer 1

Delivery between 24 and 36+6 weeks.

Question 2

How common are pre term births

Answer 2

6-7 percent

Question 3

What is the survival rate of babies born at 24 weeks

Answer 3

20-30 percent

Question 4

At what gestation does the survival rate of pre terms become almost 100 percent

Answer 4

32 weeks

80 percent from 27weeks

Question 5

What are the most likely causes for a pre term birth

Answer 5

Infection
Over distention - multiple pregnancies, polyhydramnois
Placental abruption
Intercurrent illness- pyeloneohritis/UTI/appendicitis/pneumonia
Cervical incompetence
Idiopathic

Question 6

What are the risk factors associated with pre term birth

Answer 6

Previous  PTL (20 percent increase x1, 40 percent increase x2)
Multiple (50 percent risk)
Uterine anomalies
Age (teenagers)
Parity (if first or more than 5)
Ethnicity 
Poor socio economic status
Smoking
Drugs (cocaine)
Low BMI (less than 20)

Question 7

What is the definition of small for gestational age

Answer 7

Infant with a birthweight that is less than 10th centile for gestation (corrected for maternal height etc)

Question 8

What maternal factors can result in IUGR

Answer 8

Smoking, alchohol, drugs
Height and weight
Age
Hypertension (maternal disease)

Question 9

What fetal factors can result in poor growth

Answer 9

Infection eg rubella
Congenital eg absent kidneys
Chromosomal eg Down’s syndrome

Question 10

What placental factors can result in IUGR

Answer 10

Infarcts
Abruption
Secondary to hypertension usually

Question 11

What is meant by symmetrical and asymmetrical IUGR

Answer 11

Symmetrical = small head AND small abdomen

Asymmetrical = normal head and small abdomen

Question 12

What are the consequences of IUGR

Answer 12

Antenatal/labour = HYPOXIA and death

Post natal = hypoglycaemia, asphyxia, hypothermia, polycythaemia, hyperbiliribinaemia, abnormal neurodevelopment

Question 13

What are the clinical features of poor growth

Answer 13

Risk factors present
Fundal height less than expected
Reduced liquor
Reduced fetal movements

Question 14

how is fetal well being assessed

Answer 14

Growth
Cardiotocography
Biophysical assessment
Doppler

Question 15

What is an accelerations?

Answer 15

An increase in fetal heart rate at the start of a uterine contraction returning to baseline rate before or after contraction.

Indicated good reflex reactivity of the fetal circulation

Question 16

At what level would the baseline fetal heart rate variability be considered reduced

Answer 16

variability of less than 5 beats/ min

Question 17

What can cause a loss of baseline variability

Answer 17

Caused by sedatives or analgesics in labour

The less variability the greater the possibility of asphyxia

Question 18

What is a late deceleration

Answer 18

any deceleration whose lowest point is past the peak of contraction

Question 19

What are decelerations associated with

Answer 19

asphyxia

Question 20

At what biophysical profile would you deliver the baby

Answer 20

0-2

4-6= repeat, 8-10 satisfactory