Small for Gestational Age

Question 1

What is described as ‘preterm’?

Answer 1

any birth before 37 weeks

extreme pre-term = 24-27+6 weeks

Question 2

What is the survival rate of a baby born >32 weeks pre-term?

Answer 2

95%

Question 3

What are some causes of pre-term delivery?

Answer 3

infection
over distention - multiple or polyhydraminous
intercurrent illness
vascular - placental abruption
idiopathic
cervical incompetence

Question 4

What are some risk factors for pre-term delivery?

Answer 4

previous pre-term labour
multiple
parity is 0 or >5
teenager
drugs (especially cocaine)
smoking
low BMI

Question 5

What does IUGR stand for?

Answer 5

Intra-uterine growth restriction

Question 6

What does LBW stand for and mean?

Answer 6

Low birth weight = below 2.5kg regardless of gestation

Question 7

How is SGA picked up at antenatal screening?

Answer 7

symphysis-fundal height less than 10th centile or multiple measurements showing slow or static growth

Question 8

How do you diagnose SGA?

Answer 8

Measurement of foetal abdominal circumference paired with femur length. can also get liqour volume/ amniotic fluid index/doppler scan

Question 9

What are the features of poor growth?

Answer 9

Reduced fundal height for gestation
reduced liquor
reduced foetal movement

Question 10

What are the three broad categories for reasons of SGA?

Answer 10

Maternal factors
Placental factors
Foetal factors

Question 11

What are the maternal factors that contribute to SGA?

Answer 11

lifestyle (smoking, alcohol, drugs)
BMI <20
age
maternal disease (usually hypertension)

Question 12

What are the placental factors that contribute to SGA?

Answer 12

infarcts or abruption

usually secondary to hypertension

Question 13

What is abruption of the placenta?

Answer 13

This is when the placenta starts to detach from the endometrium prematurely - can cause abdo pain, bleeding and contractions.

Question 14

What are the foetal factors for SGA?

Answer 14

Infection (rubella, CMV, toxoplasma)
congenital (absent kidneys)
chromosomal abnormalities (down’s syndrome)

Question 15

What are some consequences of IUGR in labour?

Answer 15

increased risk of hypoxia and death

Question 16

What are the consequences of IUGR post-natally?

Answer 16

Hypoglycaemia
effects of asphyxia
hypothermia
polycythemia
hyperbilirubinaemia
abnormal neurological development

Question 17

How do you asses foetal wellbeing?

Answer 17

doppler ultrasound
biophysical assessment
cardiotocography
assessment of growth

Question 18

What does a biophysical profile look at?

Answer 18

• foetal movements
• foetal heart rate
• foetal lung movements
• liquor volume

Question 19

What is the scoring system of a biophysical profile?

Answer 19

8-10 = normal (satisfactory)
4-6 = repeat
0-2 = deliver

Question 20

What does the umbilical artery doppler look at?

Answer 20

placental resistance to flow (USS)

Question 21

What will the MCA doppler look at and why?

Answer 21

Foetal middle cerebral artery to look at resistance to flow. Will be good indicator of foetal cardiac stress, foetal anaemia or hypoxia

Question 22

What is normal in MCA doppler?

Answer 22

for resistance to be high

Question 23

What is abnormal in MCA doppler?

Answer 23

for resistance to flow to be low

Question 24

What should be given if considering a pre-term delivery?

Answer 24

Steroids and magnesium sulphate

Question 25

Why do you give magnesium sulphate and steroids in pre-term labour?

Answer 25

Magnesium sulphate = for neuroprotection of the foetus

Steroids = to aid development and maturation of the foetal lungs (should be given multiple injections if possible)

Question 26

What are tocolytic drugs?

Answer 26

these are drugs that will slow/hault labour