Problems in Pregnancy: Small for dates

Question 1

What are teh causes of a small baby?

Answer 1

preterm delivery; small for gestational age

Question 2

What can cause a baby to be small fro gestational age?

Answer 2

intra-uterine growth restriction or constitutionally small

Question 3

What is the definition of preterm birth?

Answer 3

delivery between 24 and 36+6 weeks

Question 4

What is the survivial rate for baby born at 24 weeks?

Answer 4

around 50%

Question 5

What is the survival rate fro a baby born at 27 weeks?

Answer 5

80%

Question 6

What is the survival rate for a baby born at 32 weeks?

Answer 6

> 95%

Question 7

What is the most common cause of preterm birth?

Answer 7

idiopathic

Question 8

What are the causes of preterm birth?

Answer 8

infection; over-distension; vascular; cervical insufficiency

Question 9

What infections are implicated in pre-term birth?

Answer 9

systemic upset- pyelonephritis; appendicitis; pneumonia

Question 10

What are the causes of over-distension?

Answer 10

multiple pregnancy; polyhydramnios; fibroids–anything that makes uterus/cervix funny shape

Question 11

What is cervical insufficiency?

Answer 11

cervic opens and shortens prematurely

Question 12

What is the cause of cervical insufficiency?

Answer 12

previous surgical damage to the cervix- e.g after cervical smear or repeated D&cs; or congential defect

Question 13

How can cervical insuffiency be treated?

Answer 13

cervical suture

Question 14

What types of infections are more common after preterm delviery?

Answer 14

neonatal sepsis; maternal postpartum endoemtritis and chorioamnionitis

Question 15

What are the risk factors for preterm birth?

Answer 15

previous PTL; multiple pregnancy; uterine anomalies; age; parity (0 or >5); poor socioeconomic status; smoking; drugs; low BMI

Question 16

What drug is especially implicated in preterm birth?

Answer 16

cocaine

Question 17

What is the purpose of giving women steroids in preterm labour?

Answer 17

helps mature baby’s lungs and reduces neonatal respiratory distress syndrome

Question 18

What are the purposes of giving tocolysis?

Answer 18

allow course of steroids and faciliatate transferring of mother

Question 19

What is small for gestational age defined as?

Answer 19

less than 10th centile for gestation

Question 20

What maternal factors are implicated in IUGR?

Answer 20

lifestyle- smoking; alcohol; drugs; BMI; age; maternal disease eg HT; loose assoc. with IVF babies

Question 21

What fetal factors are implicated in IUGR?

Answer 21

chromosomal abnormalities; congenital anomalies; infection - rubella; CMV; toxoplamsa

Question 22

What placental factors are implicated in IUGR?

Answer 22

infarcts and abruptions

Question 23

What is the usual cause of placental IUGR?

Answer 23

secondary to HT

Question 24

What is the difference bewteen symmetrical and asymmetrical IUGR?

Answer 24

symmetrical- head and abdo are both small; asymmetrical- normal head, small abdo

Question 25

What does symmetrical IUGR indicate?

Answer 25

chromosome or early onset problems

Question 26

What are teh consequences of being growth restricted antenatally/in labour?

Answer 26

risk of hypoxia or fetal death

Question 27

what are the postnatal consequences of growth restriction?

Answer 27

hypoglycaemia; hypothermia; effects of asphyxia; polycythaemia; jaundice; abnoraml neurodevelopment

Question 28

What are the clinical features of IUGR?

Answer 28

predisposing factors; fundal height less; reduced liquor; reduced fetal movements

Question 29

What is fundal height?

Answer 29

symphyseal-fundal height should match gestation +/-2cm

Question 30

How is fetal growth assessed on USS?

Answer 30

abdomen; femur length; head circumference

Question 31

What does cardiotocography assess?

Answer 31

fetal HR and contractions

Question 32

What is looked for on cardiotocography?

Answer 32

baseline rate; basline variability; accelerations; decelerations

Question 33

What is normal fetal HR?

Answer 33

110-150

Question 34

What is short term variability?

Answer 34

interval between successive heart beats varies

Question 35

What do fetal acceleratiosn indicate?

Answer 35

good fetal circulation

Question 36

What is loss of basline variability defined as?

Answer 36

less than 5 beats/min

Question 37

What causes loss of baseline variability?

Answer 37

can be fetal sleep; analgesic drugs in labour; or asyphxia

Question 38

What causes decelrations?

Answer 38

placental insufficiency

Question 39

What should be done if there is decelerations?

Answer 39

fetal blood sample to look at pH

Question 40

What factors are considered in biophysical profile of fetus?

Answer 40

movement; tone; fetal breathing movemetns and liqour volume

Question 41

Why would there be a decrease in amniotic fluid volume if the placenta isnt working well?

Answer 41

decreased renal perfusion so decreased urine production or ruptured membraen

Question 42

What does doppler of umbilical artery measure?

Answer 42

placental resistance to flow

Question 43

what do you look at on doppler of umbilical artery?

Answer 43

ratio between peaks-systolic flow; and troughs-diastolic flow

Question 44

What does absent end-diastolic flow mean?

Answer 44

poor placental flow- high resistance: baby in danger

Question 45

What does reverse end-diastolic flow mean?

Answer 45

very bad!

Question 46

Why is an MCA doppler done?

Answer 46

indicates oxygenation- faster flow in MCA indicates fetus is redirecting blood to heart and brain: cerebral redistribution

Question 47

What oes a ductus venosus doppler indicate?

Answer 47

cardiac contractility