Small and Large Births Flashcards
What is defined as preterm delivery?
Delivery before 37 weeks gestation
Give some potential causes for preterm birth
Infection Over distention Placental abruption Illness (pyelonephritis/appendicitis etc.) Cervical incompetence
Give some risk factors for preterm birth
Previous preterm delivery Multiple pregnancy Young age Smoking Low BMI Cocaine use
What is a small for gestational age foetus?
When estimated foetal weight/abdo circumference is below 10th centile
What is defined as a low birth weight?
Birth weight below 2.5kg
Give some risk factors for SGA foetus
Older maternal age Smoker Previous SGA Hypertension High BMI Pre-eclampsia
How is SGA screened for during antenatal care?
Measurement of symphysial-fundal height from 24 weeks
How is SGA diagnosed?
Measuring foetal abdo circumference and combining with head circumference +/- femur length
Give some maternal factors that can lead to SGA
Smoking/alcohol/drugs
Height and weight
Young age
Give some placental factors that can lead to SGA
Infarcts
Abruption
Give some foetal factors that can lead to SGA
Infection (rubella/CMV/toxoplasma)
Congenital abnormalities
Chromosomal abnormalities
What scan can be done to assess the umbilical artery?
Doppler USS
Give some indications for earlier delivery by C-section
Growth becomes static
Abnormal umbilical artery USS
What medical management should be considered if planning early delivery?
Steroids
Magnesium sulfate
What is defined as large for dates?
Symphyseal-fundal height >2cm for gestational age
What is foetal macrosomia?
When USS estimated foetal weight >90th centile
What is polyhydramnios?
Excess amniotic fluid (AFI >25cm)
Give some causes of polyhydramnios
Maternal diabetes
Foetal anomaly
Monochorionic twin pregnancy
Viral infection
Give some clinical features of polyhydramnios
Abdo discomfort Preterm labour Cord prolapse Tense shiny abdomen Inability to feel foetal parts
What investigation is done to diagnose polyhydramnios?
USS
Give some risks of polyhydramnios during labour
Malpresentation
Cord prolapse
Give some risks for multiple pregnancy
Assisted conception African race FHx Increased maternal age Increased parity Tall mothers
What is chorionicity?
The number of placentas present (i.e. monochorionic = 1)
What investigation is done to confirm chorionicity?
USS
Give some clinical features of multiple pregnancy
Exaggerated pregnancy symptoms (HG)
High AFP
Large for dates uterus
Give some foetal complications of multiple pregnancy
Higher perinatal mortality
Congenital anomalies
Pre-term birth
Cerebral palsy
Give some maternal complications of multiple pregnancy
Hyperemesis gravidarum
Anaemia
Pre-eclampsia
Preterm labour
What medications are used in the management of multiple pregnancy?
Iron supplementation
Low dose aspirin
Folate
How often are USS carried out in monochorionic and dichorionic pregnancies?
MC - 2 weekly from 16/40
DC - 4 weekly
Give some complications of a monochorionic twin pregnancy
Single foetal death
Selective growth restriction
Twin anaemia-polycythaemia sequency
What is gestational diabetes?
When carbohydrate intolerance results in hyperglycaemia with first recognition during pregnancy
In a patient with type 1/2 diabetes - what is the aim for HbA1c before starting pregnancy?
48mmol/mol
Give some risk factors for gestational diabetes
Previous GDM BMI >30 Previous big baby Polyhydramnios Glycosuria
Why does gestational diabetes occur?
There is overgrowth of insulin sensitive tissues and placental hormones cause insulin resistance
What values are diagnostic for gestational diabetes on an oral glucose tolerance test?
Fasting > 5.1 mmol/l
2 hour > 8.5 mmol/l
What glycaemic targets are aimed for during pregnancy?
Fasting = 3.5-5.5 mmol/l
1 hour = <7.8 mmol/l
When is timing of delivery aimed for in patients with gestational diabetes?
Insulin treatment = 38 weeks
Metformin = 39-40 weeks
Diet alone = 40-41 weeks
What supplement should be given to diabetic women in pregnancy?
Folate 5mg
