Small baby

Question 1

What is the difference between ‘small for gestational age’ and ‘intrauterine growth restriction’?

Answer 1

Small for gestational age - foetus has grown normally but is constitutionally small (estimated birth weight and/or abdominal circumference less than 10th percentile) or has chronic compromise resulting from placental insufficiency

IUGR - foetus has failed to achieve its growth potential, usually due to a pathological cause

Question 2

The uterus can be palpated abdominally at how many weeks gestation?

Answer 2

12 - 14 weeks

Question 3

At what age does the fundus reach the umbilicus?

Answer 3

20 weeks - after 28 weeks, each gestational week is measured as a 1cm increase in the symphysiofundal height (i.e. 36cm = 36 weeks)

Question 4

What are the antepartum risks of IUGR?

Answer 4

• Hypoxia

- IU death

Question 5

What are the peripartum risks of IUGR?

Answer 5

• Hypoxia
• IU death
• Meconium aspiration (poo) - this is a sign of foetal distress
• Need for C-section/instrumental delivery

Question 6

What are the postpartum risks of IUGR?

Answer 6

• Neonatal hypoglycaemia
• Hypocalcemia
• Hypothermia
• Polycythaemia
• Hypoxic-ischaemic encephalopathy
• Developmental delay and cerebral palsy
• Learning difficulties

Question 7

What defines a small baby?

Answer 7

<2.5kg or below the 10th percentile

Question 8

What causes asymmetrical IUGR?

Answer 8

Head circumference normal but small abdominal circumference - this is due to a problem IN THE SECOND/THIRD TRIMESTER eg. placental problems, maternal chronic problems, pre-eclampsia, severe malnutrition, substance abuse, smoking - this has a better prognosis than symmetrical IUGR

Question 9

What causes symmetrical IUGR?

Answer 9

Small head and abdominal circumference - this is due to a problem IN THE FIRST TRIMESTER, such as intrauterine infections, chromosomal abnormalities, inborn errors of metabolism, irradiation, substance abuse or congenital infections

Question 10

What are the maternal causes of SGA?

Answer 10

Anaemia
Smoking
Substance misuse
Pre-eclampsia
Hypertension
Diabetes
Malnutrition
Thrombophilia
Multiple pregnancy

Question 11

What factors go into a personalised growth chart?

Answer 11

Age, height, weight, parity, ethnicity, weight of previous babies

Question 12

Growth scans look at..

Answer 12

• Growth chart
• Doppler scans
• Amniotic fluid index

Question 13

What can oligohydramnios be a sign of?

Answer 13

IUGR, usually associated with placental insufficiency

Question 14

What is PAPP-A?

Answer 14

A hormone produced by the placenta in pregnancy. Low levels can indicate SGA, or often Downs syndrome