Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 - GOSH > Small / Large for Gestational Age > Flashcards

Small / Large for Gestational Age Flashcards

1
Q

What is meant by small for gestational age (SGA)?

A

when a fetus measures below the 10th centile for their gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What ultrasound measurements are used to assess fetal size?

A
  • estimated fetal weight (EFW)
  • fetal abdominal circumference (AC)

(abdominal circumference is always measured at the level of T12)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What ultrasound measurements can be used to calculate EFW?

A
  • biparietal diameter (BPD)
  • head circumference (HC)
  • abdominal circumference (AC)
  • femur length (FL)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is used to assess the size of the fetus?

A

customised growth charts

  • these are based on the mother’s weight, height, parity + ethnic group
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is severe SGA?

A

when the fetus is below the third centile for their gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a low birth weight?

A

birth weight of less than 2500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is fetal growth monitored on a customised growth chart?

A
  • both symphysis-fundal height** and **estimated weight by scan are plotted on the chart
  • growth can be compared to the decile lines
  • and any plateau in growth can be detected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 categories of causes of SGA?

A

constitutionally small:

  • the fetus is small in size but matches the mother / others in the family
  • it is growing appropriately on the growth chart

fetal growth restriction (IUGR):

  • there is a small fetus or one that is not growing as expected
  • this is due to pathology reducing the delivery of oxygen / nutrients to the fetus through the placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 2 categories of causes of intrauterine growth restriction?

(IUGR = FGR)

A
  • placenta mediated growth restriction
  • non-placenta mediated growth restriction
    • small due to genetic / structural abnormality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What causes placenta mediated growth restriction?

A

conditions that affect the transfer of nutrients across the placenta:

  • pre-eclampsia
  • maternal smoking / alcohol
  • anaemia
  • malnutrition
  • infection
  • maternal health conditions
  • idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes non-placenta mediated growth restriction?

A

pathology of the fetus, such as:

  • genetic abnormalities
  • structural abnormalities
  • fetal infection
  • errors of metabolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Other than SGR, what other factors can suggest IUGR?

A
  • reduced amniotic fluid volume
  • abnormal doppler studies
  • reduced fetal movements
  • abnormal CTGs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the short-term complications of IUGR?

A
  • fetal death / stillbirth
  • birth asphyxia
  • neonatal hypothermia
  • neonatal hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the long-term implications for growth-restricted babies?

A
  • cardiovascular disease (particularly hypertension)
  • diabetes
  • obesity
  • mood / behavioural problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the modifiable risk factors for SGA?

A
  • obesity
  • smoking
  • diabetes
  • existing hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the non-modifiable risk factors for SGA?

A
  • previous SGA baby
  • pre-eclampsia
  • older mother (over 35)
  • multiple pregnancy
  • low PAPP-A
  • antepartum haemorrhage
  • antiphospholipid syndrome
17
Q

How are low-risk women monitored for SGA?

A

monitoring the symphysis-fundal height (SFH):

  • this is performed at every antenatal appointment from 24 weeks
  • SFH is plotted on a customised growth chart
18
Q

What is done in low-risk women if SFH is below the 10th centile?

A

women are booked for serial growth scans with umbilical artery doppler

18
Q

What is done in low-risk women if SFH is below the 10th centile?

A

women are booked for serial growth scans with umbilical artery doppler

19
Q

When are women booked for serial growth scans with umbilical artery doppler?

A
  • 3** or more **minor risk factors
  • 1** or more **major risk factors
  • issues with measuring the SFH
    • e.g. large fibroids / BMI > 35
20
Q

What is measured on serial USS scans for women with SGA or at risk of SGA?

A
  • estimated fetal weight (EFW)** and **abdominal circumference (AC) to determine growth velocity
  • umbilical arterial pulsatility index (UA-PI) to measure flow through the umbilical artery
  • amniotic fluid volume

these tend to be performed every 4 weeks from 28 weeks gestation

21
Q

What are the critical management steps for SGA?

A
  • identify those at risk of SGA
  • aspirin** to anyone at risk of **pre-eclampsia
  • treat modifiable RFs (e.g. smoking)
  • serial growth scans to monitor growth
  • early delivery where growth is static (or other concerns)
22
Q

What investigations are performed to identify the underlying cause of SGA?

A
  • blood pressure + urine dip for pre-eclampsia
  • uterine artery doppler scanning
  • detailed fetal anatomy scan by fetal medicine
  • karyotyping for chromosomal abnormalities
  • testing for infections
    • syphilis
    • malaria
    • toxoplasmosis
    • cytomegalovirus
23
Q

When is early delivery considered and why?

A
  • when growth is static on growth charts
  • OR there are other problems (e.g. abnormal Dopplers)
  • early delivery reduces the risk of stillbirth
24
Q

What is meant by large for gestational age (macrosomia)?

A
  • an estimated fetal weight above the 90th centile
  • newborn weight > 4.5kg
25
Q

What are the causes of macrosomia?

A
  • constitutional
  • maternal diabetes
  • previous macrosomia
  • maternal obesity / rapid weight gain
  • overdue
  • male baby
26
Q

What are the risks to the mother associated with macrosomia?

A
  • shoulder dystocia
  • failure to progress
  • perineal tears
  • instrumental delivery / C-section
  • postpartum haemorrhage
  • uterine rupture (rare)
27
Q

What are the risks to the fetus associated with macrosomia?

A
  • birth injury
    • e.g. Erbs palsy
    • clavicular fracture
    • fetal distress / hypoxia
  • neonatal hypoglycaemia
  • obesity in childhood / later life
  • T2DM in adulthood
28
Q

What are the investigations for a large for gestational age fetus?

A
  • USS to exclude polyhydramnios + estimate the fetal weight
  • oral glucose tolerance test for gestational diabetes
29
Q

What is the advice about delivery of a macrosomic fetus?

A
  • most women with a large for gestational age fetus will have a successful vaginal delivery
  • induction of labour** is **AVOIDED in macrosomia
30
Q

What is the main risk associated with macrosomia during delivery?

A

shoulder dystocia

31
Q

How is the risk of shoulder dystocia diminished during delivery?

A
  • delivery on a consultant led unit with experienced midwife / consultant
  • access to a theatre if required
  • early decision for C-section if required
  • active management of the third stage

Y4 - GOSH (62 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions