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Reproduction > Small for Date Pregnancies > Flashcards

Small for Date Pregnancies Flashcards

1
Q

What are the causes of small babies?

A

Preterm delivery
Small for gestational age (SGA) = intrauterine growth restriction (IUGR), foetal growth restriction (FGR), constitutionally small

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2
Q

What is preterm delivery defined as?

A

Delivery <37 weeks gestation

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3
Q

What are the different categories of preterm delivery?

A

Extreme preterm = 24-27+6 weeks
Very preterm = 28-31+6 weeks
Moderate/late preterm = 32-36+6 weeks

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4
Q

How common are preterm deliveries?

A

6-7% of deliveries in the UK

1 in 10 pregnancies globally

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5
Q

What are the preterm delivery survival rates?

A

19% at 23 weeks
40% at 24 weeks
>95% if beyond 32 weeks

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6
Q

What are some aetiologies of preterm delivery?

A

Infection, placental abruption, or idiopathic
Pyelonephritis/UTI, appendicitis or pneumonia
Overdistension = multiple pregnancy, polyhydramnios
Cervical incompetence or idiopathic

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7
Q

What are the risk factors for preterm delivery?

A

Previous preterm labour, multiple pregnancy, uterine anomalies, teenager, parity of 0 or >5, ethnicity, poor socio-economic class, smoking, BMI <20, drugs

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8
Q

What are the indications for a planned preterm C-section?

A

Accounts for 25% of preterm births = severe pre-eclampsia, kidney disease, poor foetal development

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9
Q

What are some emergency events that would lead to preterm labour?

A

Account for 25% of preterm births = placental abruption, infection, eclampsia

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10
Q

What are some common causes of preterm labour?

A

40% due to unknown cause

20% due to premature membrane rupture

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11
Q

What is small for gestational age defined as?

A

Estimated foetal weight (EFM) or abdominal circumference below 10th centile

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12
Q

What are IUGR and FGR a sign of?

A

Failure to achieve growth potential

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13
Q

What are the two types of growth restriction?

A 
Symmetrical = small head and small abdomen
Asymmetrical = normal head, small abdomen
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14
Q

What is used to identify small for gestational age babies?

A

Antenatal risk factors and screening

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15
Q

What are some minor antenatal risk factors for SGA?

A

Age >=35, IVF, nulliparity, BMI <20 or 25-34.9, 1-10 cigarettes/day, previous pre-eclampsia, low fruit pre-pregnancy, pregnancy interval <6 months or >=60 months

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16
Q

What are some major antenatal risk factors for SGA?

A

Age >40, >11 cigarettes/day, parental SGA, cocaine, daily vigorous exercise, previous SGA baby, previous stillbirth, chronic hypertension, diabetes, renal impairment, antiphospholipid syndrome, low PAPP-A, BMI>35, large fibroids, foetal echogenic bowel, heavy bleeding in pregnancy

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17
Q

How is SGA screened for?

A

All women have measurement of symphysial-fundal height from 24 weeks

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18
Q

When would you do a growth scan for suspected SGA?

A

If single symphysial-fundal height below 10th centile

19
Q

What would a growth chart for SGA show?

A

Serial measurements suggest slow/static growth

20
Q

How is SGA diagnosed?

A

Measurement of foetal AC then combine with head circumference +/- femur length to give EFW

21
Q

What additional measurements can be taken to aid diagnosis of SGA?

A

Liquor volume or amniotic fluid and may do Doppler

22
Q

What maternal factors influence SGA?

A

Lifestyle = smoking, alcohol, drugs

Height, weight, age and maternal disease

23
Q

When are uterine artery Dopplers performed?

A

All women have them performed as part of their 20 week scan

24
Q

What are the placental factors that influence SGA?

A

Infarcts, abruption, dysfunction

25
Q

What foetal factors influence SGA?

A

Infection = rubella, CMV, toxoplasma

Congenital anomalies and chromosomal abnormalities

26
Q

What is the link between early SGA and chromosomal abnormalities?

A

1 in 5 babies thought to be SGA <24 weeks will have chromosomal abnormality

27
Q

What does IUGR carry a risk of during labour?

A

Hypoxia and death

28
Q

What are the postnatal consequences of IUGR?

A

Hypoglycaemia, effects of asphyxia, hypothermia, polycythaemia, hyperbilirubinaemia, abnormal neurodevelopment

29
Q

What are the clinical features of poor growth?

A

Predisposing factors, fundal height less than expected, reduced liquor, reduced foetal movements

30
Q

How is foetal wellbeing assessed?

A

Growth scans with Doppler assessment, CTG, biophysical assessment

31
Q

What is a biophysical assessment?

A

US combined with CTG = considers movement, tone, foetal breathing movements and liquor volume

32
Q

How is a biophysical assessment scored?

A

Out of 10 = score of 8-10 is satisfactory, repeat if score is 4-6, deliver if score 0-2

33
Q

What is the primary tool for monitoring foetal wellbeing?

A

Umbilical artery Doppler = uses US to give measurement of placental resistance to flow

34
Q

What does the results of an umbilical artery Doppler mean?

A

Normal = constant flow to baby (even in diastole)

Developing resistance = absent diastolic flow, flow may eventually reverse (foetus not getting nutrition)

35
Q

What are some additional Dopplers that may be done to assess foetal wellbeing?

A

MCA and ductus venosus Dopplers

36
Q

When would you deliver a SGA?

A

37 weeks irrespective of growth trajectory (as long as everything is well)

37
Q

What are the indications for an early C-section to deliver a SGA baby?

A

Growth becomes static
Abnormal umbilical artery Doppler
Normal UA Doppler with abnormal MCA between 32-37 weeks
Abnormal UA Doppler with abnormal ductus venosus Doppler between 24-32 weeks

38
Q

What is the timing of delivery for a SGA baby a balance of>

A

The risks of prematurity and the potential hypoxia in utero or stillbirth

39
Q

What centiles on a growth chart would indicate a constitutionally small baby?

A

babies between the 3rd and 10th centiles

40
Q

What are the causes of symmetrical IUGR?

A

Congenital, chromosomal, intra-uterine infection, environmental

41
Q

What are the causes of asymmetrical IUGR?

A

Pre-eclampsia, placental abruption, smoking

42
Q

What does it suggest if the ductus venosus Doppler is pulsatile or has high resistance?

A

May suggest baby is becoming acidotic

43
Q

Why does the middle cerebral artery decrease its resistance?

A

To maintain blood flow to the foetal brain

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