Small for dates

Question 1

Pre-term delivery

Answer 1

deliver <37 weeks gestation

Question 2

extreme pre-term

Answer 2

24 - 27+6 weeks

Question 3

very pre-term

Answer 3

28 - 31+6 weeks

Question 4

moderate to late pre-term

Answer 4

32 - 36+6 weeks

Question 5

list some risk factors for pre-term birth.

Answer 5

previous PTL
multiple 
uterine anomalies 
teenager
parity (=0 or >5)
ethnicity 
poor socioeconomic status
smoking
drugs esp. cocaine
BMI <20

Question 6

What constitutes a small for gestational age (SGA) foetus?

Answer 6

estimated foetal weight or abdominal circumference <10th centile
Failure to achieve growth potential (IUGR/FGR)
Birth weight <2.5kg (regardless of gestation)

Question 7

What is growth restriction divided into? Describe each category.

Answer 7

Symmetrical and asymmetrical.
Symmetrical = small head and body.
Asymmetrical = normal head, small body.

Question 8

What might cause symmetrical growth restriction?

Answer 8

chromosome abnormality, intrauterine infection, environmental condition.

Question 9

What might cause an asymmetrical growth restriction?

Answer 9

placental reasons - baby is diverting blood to head to protect brain growth over other less vital organs.
smoking

Question 10

Describe the level of monitoring for a woman with major antenatal risk factors for an SGA baby.

Answer 10

A single major risk factor means that foetal size will be measured at 26/28 weeks and then regularly until birth.

“serial growth scans” = minimum 28, 32 and 36 weeks

Question 11

Minor antenatal risk factors for SGA foetus.

Answer 11

maternal age >/= 35 
IVF pregnancy
nulliparity 
BMI <20
1-10 cigarettes/day 
low fruit pre-pregnancy
previous pre-eclampsia 
pregnancy interval <6 months 
pregnancy interval >60 months

Question 12

How many minor antenatal risk factors are needed to require a growth scan at 34 weeks?

Answer 12

3 minor risk factors

Question 13

Major antenatal risk factors for SGA foetus.

Answer 13

maternal age >40
smoker >= 11 /day 
paternal/maternal SGA
cocaine use
daily vigorous exercise
previous SGA baby
previous stillbirth
chronic hypertension
diabetes with vascular disease
renal impairment
anti-phospholipid syndrome
heavy bleeding in pregnancy 
low PAPP-A
BMI >35
known large fibroids

Question 14

What measurement do all pregnant women get?

Answer 14

symphyseal-fundal height from 24 weeks

Question 15

What is needed to diagnose SGA?

Answer 15

measure foetal abdominal circumference

combine with head circumference ± femur length to give EFW

Question 16

What additional information can help diagnose SGA?

Answer 16

liquor volume or amniotic fluid index and Dopplers

Question 17

What is the minimum to consider when looking at customised growth charts?

Answer 17

maternal parity
BMI
ethnicity

Question 18

When do women in Tayside have uterine artery doppler’s performed? What is expected to be seen?

Answer 18

performed as part of 20 week scan
pregnancy should be a low resistance state - uterine arteries should become low resistance vessels in 2nd trimester with forward flow to the placenta even in diastole.

Question 19

What abnormality might you see on uterine artery doppler and what is mother at risk of?

Answer 19

if resistance is seen in both uterine arteries the woman is at risk of SGA and hypertensive disease in pregnancy.

Question 20

What are some clinical features of poor foetal growth?

Answer 20

(predisposing factors)
fundal height < than expected
reduced liquor
reduced foetal movements

Question 21

When assessing a foetus using its biophysical profile - what is being looked for?

Answer 21

movement
tone
foetal breathing movements
liquor volume

score out of 10: 8-10 fine; 4-6 repeat; 0-2 deliver.

Question 22

What does ductus venous allow?

Answer 22

key in foetal circulation to allow shunting of oxygenated blood to by-pass the liver and move via IVC to oxygenate the brain

Question 23

What are the indications for considering earlier delivery by C/S?

Answer 23

growth becomes static
abnormal uterine artery doppler
normal umbilical artery doppler with abnormal MCA between 31-37 weeks
abnormal umbilical artery doppler with abnormal ductus venous doppler at 24-32 weeks.

Question 24

what two drugs are given if planning early delivery?

Answer 24

steroids and magnesium sulphate

Question 25

Why give steroids?

Answer 25

promote foetal lung maturity - given if delivery planned <36 weeks

Question 26

Why would magnesium sulphate be given?

Answer 26

provides some foetal neuroprotection against cerebral palsy if delivery <32 weeks