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Small and Large Births Flashcards

1
Q

What is defined as preterm delivery?

A

Delivery before 37 weeks gestation

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2
Q

Give some potential causes for preterm birth

A 
Infection
Over distention
Placental abruption
Illness (pyelonephritis/appendicitis etc.)
Cervical incompetence
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3
Q

Give some risk factors for preterm birth

A 
Previous preterm delivery
Multiple pregnancy
Young age
Smoking
Low BMI
Cocaine use
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4
Q

What is a small for gestational age foetus?

A

When estimated foetal weight/abdo circumference is below 10th centile

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5
Q

What is defined as a low birth weight?

A

Birth weight below 2.5kg

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6
Q

Give some risk factors for SGA foetus

A 
Older maternal age
Smoker
Previous SGA
Hypertension
High BMI
Pre-eclampsia
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7
Q

How is SGA screened for during antenatal care?

A

Measurement of symphysial-fundal height from 24 weeks

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8
Q

How is SGA diagnosed?

A

Measuring foetal abdo circumference and combining with head circumference +/- femur length

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9
Q

Give some maternal factors that can lead to SGA

A

Smoking/alcohol/drugs
Height and weight
Young age

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10
Q

Give some placental factors that can lead to SGA

A

Infarcts

Abruption

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11
Q

Give some foetal factors that can lead to SGA

A

Infection (rubella/CMV/toxoplasma)
Congenital abnormalities
Chromosomal abnormalities

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12
Q

What scan can be done to assess the umbilical artery?

A

Doppler USS

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13
Q

Give some indications for earlier delivery by C-section

A

Growth becomes static

Abnormal umbilical artery USS

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14
Q

What medical management should be considered if planning early delivery?

A

Steroids

Magnesium sulfate

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15
Q

What is defined as large for dates?

A

Symphyseal-fundal height >2cm for gestational age

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16
Q

What is foetal macrosomia?

A

When USS estimated foetal weight >90th centile

17
Q

What is polyhydramnios?

A

Excess amniotic fluid (AFI >25cm)

18
Q

Give some causes of polyhydramnios

A

Maternal diabetes
Foetal anomaly
Monochorionic twin pregnancy
Viral infection

19
Q

Give some clinical features of polyhydramnios

A 
Abdo discomfort
Preterm labour
Cord prolapse
Tense shiny abdomen
Inability to feel foetal parts
20
Q

What investigation is done to diagnose polyhydramnios?

A

USS

21
Q

Give some risks of polyhydramnios during labour

A

Malpresentation

Cord prolapse

22
Q

Give some risks for multiple pregnancy

A 
Assisted conception
African race
FHx
Increased maternal age
Increased parity
Tall mothers
23
Q

What is chorionicity?

A

The number of placentas present (i.e. monochorionic = 1)

24
Q

What investigation is done to confirm chorionicity?

A

USS

25
Q

Give some clinical features of multiple pregnancy

A

Exaggerated pregnancy symptoms (HG)
High AFP
Large for dates uterus

26
Q

Give some foetal complications of multiple pregnancy

A

Higher perinatal mortality
Congenital anomalies
Pre-term birth
Cerebral palsy

27
Q

Give some maternal complications of multiple pregnancy

A

Hyperemesis gravidarum
Anaemia
Pre-eclampsia
Preterm labour

28
Q

What medications are used in the management of multiple pregnancy?

A

Iron supplementation
Low dose aspirin
Folate

29
Q

How often are USS carried out in monochorionic and dichorionic pregnancies?

A

MC - 2 weekly from 16/40

DC - 4 weekly

30
Q

Give some complications of a monochorionic twin pregnancy

A

Single foetal death
Selective growth restriction
Twin anaemia-polycythaemia sequency

31
Q

What is gestational diabetes?

A

When carbohydrate intolerance results in hyperglycaemia with first recognition during pregnancy

32
Q

In a patient with type 1/2 diabetes - what is the aim for HbA1c before starting pregnancy?

A

48mmol/mol

33
Q

Give some risk factors for gestational diabetes

A 
Previous GDM
BMI >30
Previous big baby
Polyhydramnios
Glycosuria
34
Q

Why does gestational diabetes occur?

A

There is overgrowth of insulin sensitive tissues and placental hormones cause insulin resistance

35
Q

What values are diagnostic for gestational diabetes on an oral glucose tolerance test?

A

Fasting > 5.1 mmol/l

2 hour > 8.5 mmol/l

36
Q

What glycaemic targets are aimed for during pregnancy?

A

Fasting = 3.5-5.5 mmol/l

1 hour = <7.8 mmol/l

37
Q

When is timing of delivery aimed for in patients with gestational diabetes?

A

Insulin treatment = 38 weeks
Metformin = 39-40 weeks
Diet alone = 40-41 weeks

38
Q

What supplement should be given to diabetic women in pregnancy?

A

Folate 5mg

Reproduction (33 decks)

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