fetal growth disorders

Question 1

which measurements are used for the estimation of fetal weight ?

Answer 1

BPD biparietal diameter 
HC head circumference 
AC abdominal circumference 
FL femur length 
all by ultrasound

Question 2

what is fetal growth rate affected by ?

Answer 2

placental function

genetic or constitutional factors

Question 3

what factors affect fetal birth weight ?

Answer 3

function of both gestational age 
rate of fetal growth

Question 4

what does appropriate for gestational weight mean ?

Answer 4

infants born with a birth weight between 10th and 90th centile for their gestational age

Question 5

what does small for gestational age mean ?

Answer 5

infants born with a birth weight less than 10th centile for their gestational age

Question 6

what does large for gestational age mean ?

Answer 6

infants born with a birth weight more than 90th centile for their gestational age

Question 7

what does fetal growth restriction mean ?

Answer 7

implies a pathological restriction of the genetic growth potential and they may show signs of fetal compromise

Question 8

what does low birth weight mean ?

Answer 8

infants with a birth weight less than 2500 g regardless of their gestational age

Question 9

when do we consider a baby to be born pre-term?

Answer 9

24 to 36 weeks

Question 10

when do we consider a baby to born early term ?

Answer 10

37-38 weeks

Question 11

when do we consider a baby to be born full term ?

Answer 11

39-40 weeks

Question 12

when do we consider a baby to be born late term ?

Answer 12

41 weeks

Question 13

when do we consider a baby to be born post term ?

Answer 13

at 42 weeks

Question 14

what can we divide babies that are born small for gestational age into ?

Answer 14

normal/constitutional
non placenta mediated growth restriction
placenta mediated growth restriction

Question 15

how do we screen for SGA ?

Answer 15

history 
biochemical markers (PAPP-A)
uterine artery doppler at 20-24 weeks gestation
 ( anomaly scan)
clinical examination

Question 16

how do we make a diagnosis of SGA ?

Answer 16

ultrasound biometry
doppler
amniotic fluid index

Question 17

what is the brain sparing syndrome ?

Answer 17

in cases of chronic placental insufficiency the fetus reacts to the restricted placental perfusion by redirecting the blood back to the brain

Question 18

what are the results of the brain sparing syndrome ?

Answer 18

1. an increased ( head circumference/ abdominal circumference ratio )
2. reduced renal perfusion and decreased urine output which causes oligohydraminous

Question 19

what can be done to prevent SGA ?

Answer 19

1. anti-platelete agents may be effective

2. cessation of smoking

Question 20

when should anti-platelete agents be commenced ?

Answer 20

should be commenced at or before 16 weeks of pregnancy

Question 21

what is the primary surveillance tool in the SGA ?

Answer 21

umbilical artery doppler

Question 22

what other blood vessels are important to asses using doppler ?

Answer 22

middle cerebral artery

ductus venous

Question 23

other than doppler what can be used for fetal surveillance in SGA ?

Answer 23

CTG
US assessment of amniotic fluid volume
biophysical profile

Question 24

what are the aspects of the biophysical profile ?

Answer 24

1. breathing movement
2. gross body movement
3. tone
4. amniotic fluid volume

Question 25

what is the management in SGA ?

Answer 25

if planning to deliver between week 24 and week 35 weeks : give antenatal corticosteroids offer Magnesium Sulphate

Question 26

what is the management if the baby with SGA has a normal umbilical artery doppler ?

Answer 26

delivery should be offered at 37 weeks with doppler follow up every 14 days

Question 27

what is the management if the baby with SGA has an abnormal umbilical arttery doppler ?

Answer 27

this depends on if the end diastolic velocities are preserved : 1. if they are ---> deliver no later than 37 weeks with doppler follow up twice weekly 2. not preserved ---> delivery should be considered between 30-32 weeks with daily follow up with doppler

Question 28

how should an SGA baby be delivered ?

Answer 28

if the end diastolic velocities are perserved then normal labour can be offered for no perserved end diastolic velocity caesarian section should be offered

Question 29

when can we call a fetus macrosomic?

Answer 29

when the fetus is born exceeding 4000 gm regardless of its gestational age

Question 30

what are the risk factors for having a macrosomic baby ?

Answer 30

``` maternal diabetes maternal obesity post-term pregnancy grand multipara previous LGA baby ```

Question 31

what are the fetal complications of macrosomia ?

Answer 31

IUFD birth trauma hypoglycemia

Question 32

what are the maternal complications of macrosomia ?

Answer 32

higher chance of CS delivery trauma to the birth canal postpartum hge

Question 33

when do we plan for an elective CS in macrosomic babies ?

Answer 33

5 kg baby in non diabetic women | 4.5kg in diabetic women