Fetal alcohol syndrome Flashcards
What is the diagnostic criteria for fetal alcohol syndrome?
- Growth retardation (before/after birth)
- Facial anomalies
- CNS abnormalities
Facial abnormalities include:
- small palpebral fissures
- indistinct or absent philtrum
- epicanthic folds
- flattened nasal bridge
- short nose length
- thin upper lip
- low-set unparallel ears
- retarded midfacial development.
What % of infants are affected by FAS?
6%
What effect does heavy alcohol use have on fetal development?
- All gestations: neurobehavioural abnormalities.
1st trimester:
- Congenital heart disease (2% vs 1% general population)
- Skeletal: contractures, chest wall deformities, scoliosis, digit issues.
- Auditory: conductive and SNHL
- Renal
- Ocular
2nd trimester: miscarriage
3rd trimester: IUGR, brain growth
What other effects does heavy alcohol use have on pregnancy outcomes?
- IUGR
- PTB
- Low BW
What screening tool can you use to identify women drinking sufficiently to potentially injure fetus?
T-ACE:
○ Tolerance: How many drinks does it take to make you feel high? How many drinks can you hold?
○ Annoyed: Have people annoyed you by criticising your drinking?
○ Cut down: Have you felt you ought to cut down on your drinking?
○ Eye opener: Have you ever had to drink first thin in the morning to steady your nerves or to get rid of a hangover?
Outline management of woman with heavy drinking in pregnancy
○ Screen all pregnant women for alcohol use.
○ Cessation and/or reduction with counselling regarding risks of use: even midpregnancy can benefit. Organise inpatient or outpatient treatment and support.
○ No consensus on safe level of alcohol consumption in pregnancy and lactation.
○ Thiamine supplementation 100 mg daily (IM or IV).
○ Ultrasound monitoring if complications e.g. growth restriction, bleeding, maternal withdrawal
○ Inform paediatrician of possibility of neonatal withdrawal.
○ Always screen for domestic abuse.
