small/large for dates Flashcards by holly strachan

definition of preterm baby

delivery before 37 weeks
extreme = 24 - 27+6
very = 28 - 31+6
moderate to late = 32 - 36+6

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aetiology of preterm birth

infection
over-distension (multiple/polyhydramnios)
vascular (placental abruption)
intercurrent illness (pyelonephritis, appendicitis, pneumonia)
cervical incompetence
idiopathic

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risk factors for preterm birth

previous PTL
multiple 
uterine abnormalities 
age (teenagers)
parity (=0 or >5)
ethnicity 
poor socio-economic status 
smoking 
drugs (esp cocaine)
low BMI (<20)

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definition of small for gestational age

estimated fetal weight or abdominal circumference below the 10th centile

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what is IGUR

intra uterine growth retardation

failure to achieve growth potential

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definition of low birth weight

brith weight below 2.5 kg (regardless of gestation)

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symmetrical vs asymmetrical IUGR

symmetrical = small head and small body 
asymmetrical = normal head and small body

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screening for SGA

symphysis fundal height
growth scan if single measurement below 10th centile on customised chart
serial measurements suggest slow/static growth

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diagnosis of SGA

measurement of fetal AC
combine with head circumference +/- femur length to give EFW
additional information may come from liquor volume or amniotic fluid index and dopplers

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maternal factors for SGA

lifestyle (smoking, alcohol, drugs)
height and weight
age
maternal disease eg HTN

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placental factors for SGA

infarcts
abruption
often secondary to HTN

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fetal factors for SGA

infections (rubella, CMV, toxoplasma)
congenital anomalies (absent kidneys)
chromosomal abnormalities (down's)

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antenatal/labour consequences of IUGR

risk of hypoxia and/or death

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post natal consequences of IUGR

hypoglycaemia 
effects of asphyxia 
hypothermia 
polycythaemia 
hyperbilirubinaemia 
abnormal neurodevelopment

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clinical features of poor growth

predisposing factors
feudal height less than expected
reduced liquor
reduced fetal movements

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what does an umbilical arterial doppler measure

placental resistance to flow

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indications for delivery earlier than 37 weeks

growth becomes static (IOL may be appropriate)
abnormal umbilical artery doppler
normal umbilical artery doppler with abnormal MCA between 32 and 37 weeks
abnormal umbilical artery doppler with abnormal ductus venous doppler between 24 and 32 weeks

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definition of large for gestational age

symphysis fundal height >2 cm for gestational age

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what is fetal macrosomia

‘big baby’

USS EFW >90th centile

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risks of fetal macrosomia

clinician and maternal anxiety
labour dystocia
shoulder dystocia
PPH

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management of fetal macrosomia

exclude diabetes
reassure
conservative vs IOL vs c-section delivery

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what is polyhdramnios

excess amniotic fluid

amniotic fluid index >25 cm

causes of polyhydramnios

maternal diabetes 
fetal anomaly (GI atresia, cardiac, tumour)
monochorionic twin pregnancy 
hydros fetalis 
fetal viral infection 
idiopathic

clinical features of polyhydramnios

abdominal discomfort 
prelabour rupture of membranes 
preterm labour 
cord prolapse 
LFD 
malpresentation 
tense shiny abdomen 
inability to feel fetal parts

diagnosis of polyhydramnios

USS amniotic fluid index >25 cm deepest vertical pocket >8 cm

investigations for polyhydramnios

oral glucose tolerance test serology (toxoplasmosis, CMV, parvovirus) antibody screen USS

management of polyhydramnios

``` serial USS (growth, LV, presentation) IOL by 40 weeks ```

risks of polyhydramnios during labour

malpresentation cord prolapse preterm labour PPH

risk factors for multiple pregnancy

``` assisted conception African race FHx increased maternal age increased parity tall women > short women ```

what is zygoisity (relating to multiple pregnancy)

``` monozygotic = splitting of a single fertilised egg dizygotic = fertilisation of 2 ova by 2 sperm ```

what is chorionicity

1 placenta/2 placentas?

what is the chorionicity of dizygous twins

always DCDA | dichorionic diamniotic

what is the chorionicity of monozygous twins

MCMA/MCDA/DCDA | depends on time of splitting of ovum

cleavage occurs when to DCDA monozygous twins

day 0 - 3

cleavage occurs when for MCDA twins

day 4 - 7

cleavage occurs when for MCMA twins

day 8 - 14

cleavage occurs with for conjoined twins

day 15 onwards

why is chorionicity important

monochorionic twins are at higher risk of pregnancy complications

USS sign for DCDA twins

lambda sign

USS sign for MCDA twins

T-sign

clinical features of multiple pregnancy

exaggerated pregnancy symptoms high AFP large for dates uterus multiple fetal poles

confirmation of multiple pregnancy

USS at 12 weeks

complications of multiple pregnancy

``` higher perinatal mortality congenital anomalies IUD pre term labour growth restriction cerebral palsy twin to twin transfusion ```

maternal complications of multiple pregnancy

``` hyperemesis gravidarum anaemia pre-eclampsia antepartum haemorrhage (abruption, placenta praaevia) preterm labour c-section ```

how regular should clinic appointments be for multiple pregnancy

every 2 weeks for MC | every 4 weeks for DC

timing of delivery in multiple pregnancy

DCDA 37-38 weeks | MCDA 36+0 with steroids

what is gestational diabetes

carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

complications specific to pre-existing maternal diabetes

congenital anomalies miscarriage IUD

complications common to pre-existing and gestational diabetes

``` pre-eclampsia polyhydromanios macrosomia shoulder dystocia neonatal hypoglycaemia ```

risk factors for gestational diabetes

``` previous GDM BMI >30 FHx ethnicity previous big baby polyhydramnios big baby glycosuria ```

glycemic targets

fasting 3.5 - 5.5 mmol/l | 1 hr <7.8 mol/l

timing of delivery in GDM

insulin treatment 38 weeks metformin treatment 39-40 weeks diet alone 40-41 weeks

folic acid supplements in GDM

5 mg