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Repro and Sexual Health > Small for dates pregnancy > Flashcards

Small for dates pregnancy Flashcards

1
Q

What is a small baby?

A

Pre-term delivery
Small for gestational age; IUGR/FGR
Constitutionally small

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2
Q

What is IUGR/ FGR?

A

Intra-uterine growth restriction

Foetal growth restriction

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3
Q

What is a preterm delivery?

A

Before 37 weeks gestation

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4
Q

What is an extreme preterm delivery?

A

24-27+6 weeks

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5
Q

What is a very preterm delivery?

A

28-31+6 weeks

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6
Q

What is a moderate to late preterm?

A

32-36+6 weeks

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7
Q

How many babies in the UK are born preterm?

A

6-7%

1 in 10 pregnancies

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8
Q

When is a pregnancy “viable”?

A

24 weeks

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9
Q

Why is preterm birth important?

A 
23 weeks; 19% 
24 weeks; 40% 
25 weeks; 66% 
26 weeks; 77% 
Beyond 32 weeks >95% survival
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10
Q

What can cause preterm birth?

A 
Infection 
Multiples
Polyhydramnios
Placental abruption 
Pyelonephritis/ UTI
Appendicitis
Pneumonia
Cervical incompetence
Idiopathic
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11
Q

What is placental abruption?

A

The premature separation of the normal-sited placenta from the uterus

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12
Q

What are RF for preterm birth?

A 
Previous PTL
Multiples 
Uterine anomalies
Teenagers
Parity 0 or >5 
Ethnicity
Poor socio-economic status
Smoking
Drugs (cocaine) 
Low BMI (<20)
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13
Q

What are the reasons why preterm birth occur?

A

25% planned c/s; severe PET, kidney disease, poor foetal development
20% PROM
25% emergency; abruption, infection, eclampsia
40% unknown

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14
Q

What is the definition of a SGA foetus?

A

Estimated foetal weight or abdominal circumference below 10th centile

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15
Q

How is SGA plotted?

A

Population centiles

Customised centiles

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16
Q

What is a low birth weight?

A

Below 2.5kg (5 pounds 5) regardless of gestation

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17
Q

What is IUGR?

A

Failure to achieve growth potential

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18
Q

What is a worrying thing to see on centiles that points towards IUGR instead of constitutionally small?

A

If a baby stars on 50th centile and then drops centiles

However is a baby is on the 9th centile, but following their centile curve; they are small but not worrying

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19
Q

Why will you get asymmetric uterine growth restriction ?

A

Placental problems

Baby is diverting blood to the head to protect brain growth over less vital organs

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20
Q

Why will you get symmetric uterine growth restriction/

A

Chromosomal abnormality or in utero infection

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21
Q

How are SGA foetuses identified?

A

Antenatal RF

Screening during antenatal care

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22
Q

What are minor risk factors for SGA foetuses?

A 
Maternal age >35 
IVF 
Nulliparity
BMI <20 or 25-34.9 
Smoker 1-10 cigarettes/day 
Low fruit pre-pregnancy
Pregnancy interval <6 months of >60 months
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23
Q

What are major risk factors for SGA foetuses?

A 
Maternal age >40 
Smoker >11 cigarettes/ day 
Paternal, maternal or previous SGA
Cocaine use
Daily vigorous exercise
Previous stillbirth 
Chronic hypertx
Diabetes with vascular disease 
Renal impairement
APS
Heavy bleeding in pregnancy 
Low PAPP-A 
Foetal echogenic bowel 
BMI >35 
Large fibroids
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24
Q

What does a single major risk factor for SGA baby mean?

A

Formally measure and monitor foetal growth by means of USS to estimate foetal size from 26-28 weeks and at regular intervals until 36 weeks
Serial growth scans

25
Q

What does 3 minor risk factors for SGA mean?

A

Growth scan at 34 weeks and if abnormal uterine artery doppler measurement at 20 weeks then they would be monitored as if a major RF

26
Q

When is symphyseal-fundal height first measured?

A

24 weeks then plotted on growth charts to identify if a formal scan is required for growth

27
Q

What would indicate need for a formal scan from SFH at 24 weeks?

A

Single measurement below 10th centile

Serial measurements suggest slow/ static growth

28
Q

How is SGA diagnosed on USS?

A 
Measurement of foetal AC  (10th c) 
Combine with head circumference +/- femur length to give EFW 
Liquor volume
Amniotic fluid index
Uterine artery doppler and MCA
29
Q

What will liquor volume tell you about the health of an SGA baby?

A

Fluid around baby = good

If low; suggest a sick baby

30
Q

What is the ideal ultrasound for measurement of AC?

A

Stomach bubble
Single rib
C-shaped umbilical vein

31
Q

What doe customised growth charts take into account?

A

Maternal parity
BMI
Ethnicity

32
Q

What chart is used in tayside for SGA?

A

International foetal growth standards; abdominal circumference

33
Q

What maternal factors can result in a small baby?

A 
Smoking
Alcohol
Drugs
Height and weight
Age
Maternal disease; hypertx or renal disease
34
Q

Will all women in tayside have a uterine artery doppler?

A

Yes; as part of 20 week scan

35
Q

What is a bad sign in a uterine artery doppler?

A

Resistance within the artery

Reduced flow in diastole

36
Q

What does resistance within the uterine artery put the mother and baby at risk for?

A

SGA
PET
BP issues

37
Q

What is the proposed pathophysiology of uterine artery resistance?

A

Abnormal placentation

Failure of spiral artery invasion

38
Q

What placental factors can result in a SGA foetus?

A

Infarcts
Abruption
2ndary to hypertx

39
Q

What foetal factors can result in SGA?

A

Infection; rubella, CMV, toxoplasmosis
Congenital anomalies; absent kidneys
Chromosomal abnormalities; DS

40
Q

What should you think if the foetus is small before 24 weeks gestation?

A

Chromosomal abnormality

41
Q

What are the antenatal/ labour risks with IUGR?

A

Hypoxia

Stillbirth

42
Q

What are the postnatal consequences of IUGR?

A 
Hypoglycemia
Asphyxia
Hypothermia
Polycythaemia
Hyperbilirubinemia
CP
43
Q

What are the clinical features of poor growth in utero?

A

Predisposing factors
Fundal height reduced
Reduced liquor
Reduced foetal movements

44
Q

How should foetal wellbeing be assessed?

A

Assessment of growth
Cardiotocography
Biophysical assessment
Doppler ultrasound

45
Q

What babies qualify for serial growth scans?

A

Any baby with AC or EFW below 10th centile

46
Q

What is a biophysical assessment?

A

USS assessment

Considers; movement, tone, foetal breathing movements, liquor volume

47
Q

What is the primary tool for monitoring SGA babies and timing of delivery?

A

Umbilical doppler assessment

Gives a measurement of placental resistance to blood flow

48
Q

Why is a MCA doppler done on foetuses?

A

If MCA is low resistance; suggests the baby is diverting blood to its head to preserve vital functions at expense of non-vital organs

49
Q

When are SGA babies delivered if no complications?

A

37 weeks

50
Q

What are indications for considering an earlier delivery in SGA foetuses?

A

Growth becomes static; IOL
Abnormal umbilical artery doppler
Normal umbilical artery doppler with abnormal MCA between 32 and 37 weeks
Abnormal umbilical artery doppler with abnormal ductus venosus doppler between 24-32 weeks

51
Q

What needs to be given to the mother if a preterm delivery is planned?

A

Steroids; to increase lung maturity and reduce NEC

Magnesium sulphate; 4 hours pre-delivery to provide foetal neural protection

52
Q

At what stages of gestation will steroids and magnesium sulphate be given in a pre-planned preterm delivery?

A

<36 weeks; steroids

<32 weeks; magnesium sulphate

53
Q

What is the balance between in preterm delivery in a SGA infant?

A

Risks of prematurity

Potential of hypoxia in utero or still birth

54
Q

What causes a symmetrical IUGR?

A

Congenital
Chromosomal
Intrauterine infection
Environemental

55
Q

What causes an asymmetrical IUGR?

A

PET
Placental causes
Smoking

56
Q

What will occur to the resistance in the ductus venosus and MCA in a distressed/ hypoxic/ acidotic foetus?

A

Ductus venosus; pulsatile and increased resistance

MCA; decreased resistance

57
Q

Does the umbilical artery have deoxygenated or oxygenated blood?

A

Umbilical artery = deoxygenated

Umbilical vein = oxygenated

58
Q

What is the role of the ductus venosus in the foetal circulation?

A

Shunts oxygenated blood past the liver to the IVC to oxygenate the brain

Repro and Sexual Health (77 decks)

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