FGR

Question 1

Why is FGR such a problem

Answer 1

Can lead to stillbirths

Question 2

What is the rate of stillbirth normally vs is FRG

Answer 2

5/1000 vs 10/1000

Question 3

What causes hypoperfusion of baby from placenta

Answer 3

Cytotrophoblasts not invading far enough into spiral arteries —> increased resistance in BVs

Question 4

Causes of FGR

Answer 4

Reduced blood flow to uterus / placenta
Placental abruption
Chromosomal anomaly
Foetal infection in PROM
Multiple preg
Smoking / drugs
Undernourishment of mother
Maternal anaemia
Pre eclampsia / CKD / AID

Question 5

What is FGR associated with in practice

Answer 5

Lots unknown
Pre eclampsia
APH
Smoking

Question 6

Define SGA

Answer 6

Infant born under 10th centile / <2.5kg

Question 7

What is FGR

Answer 7

foetus failed to reach growth potential

Question 8

How is SGA different from FGR

Answer 8

SGA is constitutionally small and can be normal

Question 9

What does growth represent in terms of pregnancy

Answer 9

Placental function

Question 10

What does antenatal screening look for

Answer 10

Pre eclampsia
IUGR

Question 11

When is FGR apparent

Answer 11

After 20 weeks

Question 12

List normal fundal heights of preg

Answer 12

12 weeks = symphysis pubis
16 weeks = between the 2
22 weeks = umbilicus
22 to 36 weeks = weeks of gestation

Question 13

When is SFH not useful

Answer 13

High BMI
Fibroids
Multi preg
Transverse lie

Question 14

3 elements of USS for FGR

Answer 14

foetal measurements
Amniotic fluid assessment
Dopplers

Question 15

What foetal measurements are done

Answer 15

Abdo circ
EFW

Question 16

When would amniotic fluid assessment be different

Answer 16

PROM
Oligohydramnios (<5th centile)

Question 17

What 2 dopplers are done

Answer 17

Maternal uterine artery
Umbilical artery

Question 18

When is uterine artery Doppler done

Answer 18

20-24 weeks ONLY

Question 19

What is uterine artery Doppler done for

Answer 19

High risk IUGR
Resistance of UAs

Question 20

What does umbilical artery Doppler show

Answer 20

Foetal compromise

Question 21

When is umbilical artery Doppler done

Answer 21

24+ weeks too

Question 22

Describe good / bad / very bad umbilical artery outcomes

Answer 22

Good = present end diastolic flow
Bad = absent EDF
Very bad = reversed EDF

Question 23

How bad is raised pulsatility index

Answer 23

Between absent and normal EDF

Question 24

What was included in the saving babies lives care bundle

Answer 24

Reduce smoking
Risk assess and surveillance of suspected FGR
Increase awareness of reduced foetal movements
Effective foetal monitoring during labour
Reduce pre term birth

Question 25

What are the moderate risk factors for FGR

Answer 25

Prev SGA or prev AGA stillbirth
Smoker / drugs
>40 years old

Question 26

What are the more severe risk factors for FGR

Answer 26

Medical conditions - CKD, HTN, AID
Prev FGR or SGA stillbirth
PAPPA <5th centile
Echogenic bowel
EFW <10th centile

Question 27

Mx of FGR

Answer 27

aspirin
Uterine artery Doppler
Serial USS (2 weeks apart)

Question 28

When is CTG done in FGR

Answer 28

if it’s really bad later on in preg

Question 29

Why is CTG not done routinely for FGR

Answer 29

CTG is looking for hypoxia acutely but FGR is chronic so won’t be picked up
Can be falsely reassuring

Question 30

When is an elective C section done for FGR

Answer 30

39 weeks

Question 31

Why is C section not done earlier / later for FGR

Answer 31

Earlier - risk of TTN
Later - risk of spontaneous labour

Question 32

Can too many contractions be bad? Why/why not?

Answer 32

Yes - can cause hypoxia to newborn due to reduced blood flow

Question 33

When is oligohydramnios common

Answer 33

FGR and PPROM

Question 34

When is polyhydramnios common

Answer 34

GDM, T1DM, placental abruption, premature labour

Question 35

How does the placenta get delivered (how does it come out uterus)

Answer 35

Uterus contracts and placenta peels off the surface