Small for Dates

Question 1

What constitutes pre term delivery?

Answer 1

before 37 weeks

Question 2

What is the % survival of those born >32 weeks?

Answer 2

91%

Question 3

What is the % survival of those born at 23 weeks?

Answer 3

19%

Question 4

What can cause preterm birth?

Answer 4

infection
overdistention - multiple births, polyhydraminos
vascular - placental abruption
intercurrent illness - pyelonephritis/UTI, appendicitis, pneumonia
cervical incompetence
idiopathic

Question 5

What are risk factors for preterm birth?

Answer 5

previous pre term labour
uterine abnormalities
parity = 0 or >5
drugs - esp cocaine
multiple babies
age - teenages
low BMI <20
smoking

Question 6

What consitutes small for gestational age?

Answer 6

estimated foetal weight or abdominal circumference <10th centile

Question 7

What can cause a baby to be small for gestational age?

Answer 7

intrauterine growth restriction - failure to meet growth potential
low birth weight - below 2.5kg

Question 8

What are the risk factors for being small for gestational age?

Answer 8

maternal age >40
smoker >11 cigarettes per day
parental or maternal SGA
daily vigorous exercise
low PAPP-A
BMI >35
antiphospholipid syndrome
known large fibroids

Question 9

When are symphyseal-fundal heights measured?

Answer 9

24 weeks

Question 10

How are small for dates diagnosed?

Answer 10

measurement of fetal abdominal circumference then combine with head circumference +/- femur length to give estimated fetal weight

Question 11

When are women given a uterine artery doppler?

Answer 11

20 weeks

Question 12

What is the role of uterine artery doppler?

Answer 12

primary tool for monitoring SGA baby
measures the resistance of the uterine artery - should be low
if there is resistance then they are at risk of SGA and hypertensive disease

Question 13

What are the consequences of intrauterine growth restriction in labour?

Answer 13

risk of hypoxia

Question 14

What are the consequences of intrauterine growth restriction postnatally?

Answer 14

hypoglycaemia
hypothermia
hyperbilirubineamia 
effects of asphyxia
polycythaemia 
abnormal neurodevelopment
risk of stillbirth

Question 15

What are the clinical features of intrauterine growth restriction?

Answer 15

reduced liquor
reduced fetal movements
fundal height less than expected

Question 16

How is intrauterine growth restriction investigated?

Answer 16

biophysical assessement - scored out of 10
assessment of growth
cardiotography
doppler ultrasound

Question 17

When should a SGA baby be delivered?

Answer 17

37 weeks if all well

Question 18

When should an SGA baby be delivered earlier than 37weeks by c/section?

Answer 18

if growth becomes static
abnormal umbillical artery doppler
normal umbillical artery doppler with abnormal Middle Cerebrel Artery between 32-37 weeks or abnormal ductus venous betwen 24-34 weeks

Question 19

What else should be given to help SGA babies?

Answer 19

steroids to promote fetal lung maturity if before 36 weeks
magnesium sulphate 4 hours before delivery if delivered before 32 weeks, reduces chance of seizure and gives neural protection