T2 L16: Fetal growth restriction Flashcards
What does SGA stand for?
Small for Gestational age fetus
Less that 10% centile estimated weight and abdominal circumference
What is IUGR?
Intrauterine growth restriction
Which ultrasound measurements can be taken to measure fetal growth?
Abdominal circumference (AC) Head circumference (HC) Femur length (FL) Liquor volume (LV) Dopplers
What are the 3 groups of SGA fetuses?
-Normal baby just small
It’s based on maternal size and ethnicity
-Non-placenta mediated growth restriction
Structural or chromosomal problem
foetal infection
Inborn errors of metabolism
-Placenta-mediated growth restriction Hypertension autoimmune disease Renal disease Diabetes
What is the difference between symmetrical and asymmetrical IUGR?
Symmetrical: groups 1 and 2
HC, AC, and FL are all reduced
Asymmetrical: group 3
AC reduced
How does the spiral artery appear in a normal pregnancy compared to a IUGR pregnancy?
There is less trophoblast invasion of the spiral artery in a IUGR pregnancy
What are some risk for IUGR pregnancy?
Maternal age >40yrs Nulliparity Low or high maternal BMI Diabetes/renal disease Smoking IVF Previous SGA infant Previous still birth
What is Nulliparity?
A woman who hasn’t given birth before
Which fetal measurement reflects fetal liver size?
Abdominal circumference
What are the consequences of hypoxia in a fetus?
Blood flow is redirected towards the heart and brain and away from the gut, kidneys, and lungs
Which ultrasound findings indicate IUGR?
Small AC
Decreased amniotic fluid
Increased blood flow to the brain
How does the fetus present when there is IUGR?
Smaller foetus
Less movement to conserve energy
Foetal heart rate as hypoxia develops
Foetal death
When are antenatal corticosteroids betamethasone/dexamethasone given?
When there is a risk of respiratory distress syndrome
The steroids will stimulate alveolar cells to produce surfactant to stop the lungs from collapsing
It’s most effective if given 7 days before delivery
When does surfactant begin to be produced naturally?
At 24 weeks and there will be enough at 34 weeks
What is the benefit of administering magnesium sulphate before a pre-term delivery?
Giving IV magnesium sulphate 24 hours before delivery reduces rates of cerebral palsy
Recommended for foetuses <30
