Small for dates pregnancy and pre-term birth

Question 1

why might a baby be small? (2)

Answer 1

premature delivery

small for gestational age (IUGR, constitutionally small)

Question 2

Pre term birth

• definition?
• causes? (5)
• risk factors? (10)

Answer 2

-delivery between 24 & 36+6 weeks

-infection
over distension (Multiple/polyhydramnios)
Vascular (placental abruption)
intercurrent illness (pyelonephritis/UTI, appendicitis, pneumonia)
Cervical incompetence)
Idiopathic

-previous PTL
multiple
uterine anomalies
age
parity (0, >5)
Ethnicity
poor socio-economic status, smoking, cocaine, Low BMI

Question 3

Small for gestational age

-definition?

Answer 3

-infant with birthweight less than 10th centile for gestation corrected for maternal height, weight, sex and birth order

Question 4

IUGR

• maternal causes? (4)
• fetal factors? (3)
• placenta factors? (3)

Answer 4

-lifestyle (smoking, alcohol, drugs)
Height & weight
Age
Maternal disease e.g. hypertension

-infection e.g. rubella, Cmv, toxoplasma
congenital anomalies e.g. absent kidneys
chromosomal abnormalities e.g. Down’s syndrome

-Infarcts
Abruption

Question 5

Describe classification of of small for dates baby?

Answer 5

tis on a post it

IUGR
symmetrical (head and abdomen both smalls something wrong from early on)
asymmetrical (head sparing effect, occurs later on an might be due to abruption/failure)

Question 6

risks of being growth restricted?

• antenatal? (1)
• post natal? (6)

Answer 6

-hypoxia/death

-hypoglycaemia
Effects of asphyxia
Hypothermia
Polycythaemia
Hyperbilirubinaemia
abnormal neurodevelopment

Question 7

Clinical features of mother with poor growth of baby? (4)

-assesment of foetus includes what? (4)

Answer 7

fundal height less than expected
Reduced liquor
Reduced foetal movements

-assessment of growth
(Use US to asses abdo and head circumference and then plot to see centiles)
Cardiotocography
(covered in another lecture)
Biophysical assessment
(US assessment considering movement, tone, foetal breathing movements and liquor vol, score out of 10)
Doppler US
(measures placental resistance flow, can also look at cerebral arteries an heart)