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3 Reproduction > Small for Dates > Flashcards

Small for Dates Flashcards

1
Q

Causes of small babies

A

Pre-term delivery

Small for gestational age

  • intrauterine growth restriction/foetal growth restriction
  • constituitionally small
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2
Q

what is a pre-term delivery

A

Delivery before 37 weeks gestation

extreme =24-27+6

Very preterm = 28-31+6

mod-late preterm= 32-36+6 weeks

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3
Q

survival rates for pre-term babies

A

23 weeks - 19%
24 weeks - 40%
25 weeks - 66%
26 weeks - 77%

> 32 weeks - >95%

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4
Q

reasons for pre-term birth

A

Infection

Over distension

  • multiple pregnancy
  • polyhydramnios

Vascular
-placental abruption

Intercurrent illness

  • pyelonephritis
  • appendicitis
  • pneumonia

Cervical incompetence

Idiopathic

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5
Q

Pre-term birth risk factors

A 
Previous preterm labour 
Multiple pregnancy 
Uterine anomalies 
Age (teenagers) 
Parity (0 or >5)
Ethnicity 
Poor socioeconomic status 
Smoking 
Drugs (cocaine) 
Low BMI <20
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6
Q

how are pre-term babies normally delivered

A

25% planned Caesarean

20% premature rupture of membranes

25% Emergency event

40% cause unknown

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7
Q

what is a small for gestational age foetus

A

Estimated foetal weight or abdominal circumference below the 10th gentile

low birth weight = birth weight below 2.5kg

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8
Q

what is an intrauterine growth restriction

A

failure to achieve growth potential

can be symmetrical (small head and small body)

or asymmetrical (small body normal head)

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9
Q

what does symmetrical growth restriction suggest

A

chromosomal abnormality

in utero infection

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10
Q

what does asymmetrical growth restriction suggest

A

placental cause for restriction

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11
Q

major risk factors for small for gestational age babies

A 
Maternal age >40 
Smoker >11 cigarets/day 
Paternal SGA 
Cocaine use 
Daily vigorous exercise 
Previous SGA baby 
Previous still birth 
Maternal SGA 
Chronic hypertension 
Diabetes with vascular disease
Renal impairment 
Antiphospholipid syndrome 
Heavy bleeding in pregnancy 
Low Papp-A
Foetal echogenic bowel 
BMI>35 
Known large fibroids
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12
Q

how do you screen for small for gestational age babies

A

Symphysial-funcdal height

if single measurement below 10th gentile go for a growth scan

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13
Q

how do you diagnose SGA

A

measurement of fetal abdominal circumference

combine with head circumference +/- femur length to give estimated foetal weight

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14
Q

Causes of a baby being small for gestational age

A

Maternal factors
Placental factors
Fetal factors

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15
Q

maternal factors for small for gestational age

A 
Smoking 
Alcohol 
Drugs 
Height and weight 
Age 
Maternal disease eg. hypertension
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16
Q

why do women get uterine artery dopplers as part of their 10 week scan

A

uterine arteries should be low resistance in the 2nd trimester

if they are found to have resistance the baby is at risk of SGA and hypertensive disease in pregnancy

most likely due to abnormal placentation

17
Q

placental factors for SGA

A

Infarcts
Abruption
Secondary to hypertension

18
Q

foetal factors for SGA

A

Infection eg. rubella, CMV, toxoplasma
Congenital anomalies eg. absent kidneys
Chromosomal abnormalities eg. downs syndrome

19
Q

what are the consequences of intrauterine growth restriction

A

Antenatal/in labour - risk of hypoxia or death

Post natal - 
hypoglycaemia 
asphyxia (hypoxia) 
hypothermia 
polycythaemia 
hyperbilirubinaemia 
abnormal neurodevelopment
20
Q

how do SGA babies usually present

A

Predisposing factors
Small fundal height
Reduced liquor
Reduced foetal movements

21
Q

how do you asses fetal wellbeing

A

assessment of growth
cardiotocography
biophysical assessment
doppler ultrasound

22
Q

what is a biophysical profile

A

ultrasound assessment of the baby

considers:
- movement
- tone
- fetal breathing movements
- liquor volume

score out of 10

8-10 satisfactory
4-6 repeat
0-2 deliver

23
Q

what is an umbilical artery doppler

A

uses ultrasound
measures placental resistance to flow

normal = constant flow of blood to baby even in diastole

24
Q

when do you deliver an SGA baby

A

if all well, deliver by 37 weeks

early delivery by Caesarian if:

  • growth becomes status
  • abnormal umbilical artery doppler
  • normal umbilical artery doppler with abnormal MCA between 32 and 37 weeks
  • abnormal umbilical artery doppler with abnormal ductus venous doppler between 24-32 weeks
25
Q

why would you give steroids in an early delivery

A

to promote foetal lung maturity and avoid foetal respiratory distress syndrome

usually if baby is <36 weeks

26
Q

why do you give magnesium sulphate in an early delivery

A

some fetal neuroprotection against cerebral palsy if delivery is planned <32 weeks

3 Reproduction (49 decks)

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