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3 Reproduction and Sexual Health > Small for Dates Pregnancies > Flashcards

Small for Dates Pregnancies Flashcards

1
Q

a small for date baby is a baby below the _ centile in weight/abdo circumference

A

10th

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2
Q

what can cause a baby to be small?

A

pre-term delivery
intrauterine growth restriction (IUGR)
small parents - physiologically small

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3
Q

pre-term delivery is defined as delivery

A

37

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4
Q

extreme preterm is defined as a baby born between _ and _ weeks

A

24 and 27+6 weeks

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5
Q

very preterm is defined as a baby born between _ and _ weeks

A

28 and 31+6 weeks

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6
Q

moderate to late preterm is defined as a baby born between _ and _ weeks

A

32 and 32+6 weeks

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7
Q

how ocmmon is preterm delivery in the UK?

A

6-7%

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8
Q

at what gestation does survival of the foetus reach 50% likelihood?

A

24 1/2 weeks

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9
Q

causes of preterm birth?

A 
infection
over distention
vascular
intercurrent ilness
cervical incompetence
idiopathic
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10
Q

what illnesses during pregnancy can cause a preterm birth?

A

pyelonephritis
UTI
appendicitis
pneumonia

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11
Q

define IUGR?

A

failure to achieve growth potential in utero

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12
Q

define LBW?

A

birth weight <2.5kg

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13
Q

how is asymmetrical IUGR different from symmetrical?

A

the head and abdomen are not proportional eg head is big, abdomen is small

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14
Q

antenatal risk factors for an SGA foetus?

A 
maternal age
smoking (>11)
low or high BMI
low fruit intake
pre-eclampsia
previous birth problems 
co-morbidities eg HT, diabetes
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15
Q

1 single risk factor for SGA in pregnancy will prompt what investigations?

A

regular growth scanning

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16
Q

at what weeks gestation do you scan to check for an SGA foetus?

A

28
32
36

17
Q

if you have 3 minor risk factors what investigations are done?

A

uterine artery doppler

scan at 34 weeks

18
Q

what growth investigation is done in all mothers regardless of risk factors?

A

24 weeks

19
Q

how is SGA diagnosed?

A
  1. measure foetal abdominal circumference + head circumference +/- femur length to find out estimated foetal weight
  2. amniotic fluid index (are they producing fluid) and doppler
20
Q

what does a uterine artery doppler indicate?

A

checks the resistance of blood flow to the baby (should be low even in diastole as forward flow to placenta should be constant)

21
Q

what maternal factors can cause an SGA baby?

A

lifestyle - smoking, alcohol, drugs
BMI
age
existing disease

22
Q

what placental factors can cause an SGA baby?

A

infarcts
abruption
eg from hypertension

23
Q

what foetal factors can cause an SGA baby?

A

infection eg rubella/CMV/toxoplasmosis
congenital anomalies eg absent kidneys
chromosomal abnormalities eg downs

24
Q

if a baby is small at 24 week scan what should you consider?

A

this could be a chromosomal abnormality (1 in 5)

25
Q

perinatal consequences of IUGR?

A 
hypoglycaemia
hypothermia
polycythaemia
hyperbilirubinaemia
abnormal neurodevelopment
26
Q

clinical features of poor growth?

A

reduced foetal movements
predisposing factors
fundal height below expected
reduced liquor

27
Q

how is foetal wellbeing assessed in an SGA baby?

A

assessment of growth
cardiotocography (do this if you’re noticing clinical features)
biophysical assessment
doppler USS

28
Q

what is a biophysical profile? what does it measure?

A

USS done for up to 20-30 mins

looks at movement, tone, foetal breathing movements, liquor volume

29
Q

when would you do a biophysical profile?

A

if you know the baby is small and you want to see if it responds well despite this

30
Q

what sign on doppler USS indicates a severe problem with the umbilical artery?

A

reverse end-diastolic flow (going under the line)

31
Q

when would you do an MCA and ductus venosus doppler?

A

32-37 weeks

normal umbilical artery doppler

32
Q

a positive MCA doppler increases what?

A

baby is shunting blood to the brain to preserve its organs

33
Q

a problematic MCA doppler means flow is __

A

high

34
Q

when would you consider earlier delivery by CS?

A

static growth

abnormal dopplers

35
Q

if both dopplers are abnormal, when would you delivery?

A

between 24 and 32 weeks

36
Q

if MCA doppler is abnormal but the umbilical artery doppler is fine, when would you deliver?

A

between 32 and 37 weeks

37
Q

when would you give steroids in pregnancy

A

up to 36 weeks gestation (2 doses 24hrs apart) to promote survival of the baby if youre planning a preterm delivery

38
Q

when would you give magnesium sulfate in pregnancy and why?

A

up to 32 weeks if planned preterm delivery; gives foetal neural protection

3 Reproduction and Sexual Health (51 decks)

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