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General Obs 2 Flashcards

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1
Q

Is it big or small ?
Is it growing normally or not?

These are two different questions. What measurements do you need?

A

for big / small - only one measurement

for growing normally - series of measurements

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2
Q

Define ‘small for dates’

A

Weight is less than 10th centile for its gestation

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3
Q

Define ‘IUGR’

A

failed to reach full growth POTENTIAL

e.g. meant to be 4kg at term but 3kg

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4
Q

Which chart uses ‘criterion referencing’ (based on mum’s height, booking weight, BMI, ethnicity & parity)?

A

Customised foetal growth chart

Top line is 90th centile, middle 50th, bottom 10th centile

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5
Q

left axis of customised foetal growth chart?

A

symphyso-fundal height (cm)

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6
Q

right axis of customised foetal growth chart?

A

estimated foetal weight (g)

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7
Q

Bottom axis of customised foetal growth chart?

A

gestation (wks)

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8
Q

at 24 wks, what would symphyso-fundal height be?

A

21-27cm (3 either side)

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9
Q

at 30 weeks, what would symphyso-fundal height be?

A

27-33cm

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10
Q

How is ‘estimated foetal weight (g)’ calculated?

A

BIOMETRY from ultrasound

or by formulas (varies hosp to hosp)

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11
Q

For foetal biometry, what are the main measurements from the ultrasound?

A

HC - head circumference
AC - abdo circumference
FL - femur length

these come together to make estimated foetal weight

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12
Q

What’s the commonest cause of IUGR ?

A

PLACENTAL INSUFFICIENCY

*foetal factors like chromosomal abnormality can also cause IUGR

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13
Q

Placental insufficiency is the most common cause of IUGR. Give me some risk factors for placental insufficiency.

A
  • pre-eclampsia!
  • smoking!!
  • twins
  • maternal malnutrition
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14
Q

Instead of actual IUGR (pathological) , they might just be constitutionally small for dates. Name 3 risk factors for Small for Dates.

A
  • low parental height
  • female foetus
  • ethnicity (inc Asian)
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15
Q

A symmetrically small fetus is more likely to be constitutionally small for dates,
… whilst an ASYMMETRICALLY small fetus is more likely to be caused by IUGR (placental insufficiency).

True or false?

A

True :)

in terms of circumferences

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16
Q

Which circumference is the first bit to slow down if placental insufficiency?

A

abdominal circumference

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17
Q

What does AFI stand for?

A

amniotic fluid index

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18
Q

How is the amniotic fluid index measured?

A

ultrasound

amount of fluid in each of the four quadrants.

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19
Q

What is a normal AFI?

A

8-18cm

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20
Q

AFI counts as oligohydramnios?

A

<5th centile for gestational age

usually <5cm

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21
Q

AFI counts as polyhydramnios?

A

> 95th centile for gestational age

usually >24cm

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22
Q

Which investigation is used for the diagnosis of IUGR?

A

ultrasound, plotting biometry on customised foetal growth chart

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23
Q

When IUGR is confirmed from the customised foetal growth chart, what investigations is the woman offered ongoing?

A

ultrasound every fortnight

umbilical artery Doppler every fortnight

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24
Q

Give me 4 SHORT TERM complications associated with IUGR?

A

perinatal asphyxia
hypo/hyperglycaemia
polycythaemia
persistent pulm HTN of newborn

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25
Give me 3 LONG TERM complications associated with IUGR?
learning difficulties behavioural problems more prone to obesity, HTN, metabolic syndrome (heart disease, stroke, T2DM)
26
Babies with IUGR are more likely to develop chronic diseases earlier. True or false?
trrruuuuee
27
What does placental insufficiency often do to amniotic fluid levels?
oligohydramnios (less amniotic fluid made by baby's kidneys bc of low renal perfusion- it's diverting blood to brain bc of chronic hypoxia)
28
What makes amniotic fluid?
baby's wee | swallows it and wees it out again
29
Name 3 causes of oligohyrdramnios
``` PROM (leaks) placental insufficiency (less renal perfusion) ``` foetal urinary tract malformations (renal agenesis) also... chromosomal abnormalities post term gestation (we dont know why)
30
Ultrasound shows oligohydramnios. If placental insufficiency is suspected, What extra test would you do?
umbilical artery Doppler
31
Why can oligohydramnios lead to muscle contractures at birth?
they cant exercise by swimming around in the amniotic fluid
32
The management of oligohydramnios depends on the underlying cause. What are the two commonest causes of oligohydramnios?
PROM | placental insufficiency
33
The earlier the oligohydramnios occurs, the _______ the prognosis.
The earlier the oligohydramnios occurs, the worse the prognosis.
34
In placental insufficiency, what would be the likely result of umbilical artery Doppler?
absent end diastolic flow. | a.k.a foetal vascular stress
35
What is a NORMAL finding on Umbilical artery Doppler?
POSITIVE end-diastolic flow
36
Midwife suspects large for dates. How would she have come to this?
serial symphyso-fundal heights crossed the 90th centile
37
What investigations in large for dates?
oral GTT ultrasound (+BP obvs)
38
Ultrasound shows that head circumference and femur length are on the 50th centile, whereas abdominal circumference is on the 95th centile. This is .....
asymmetrical macrosomia
39
What is the difference between large for dates and macrosomia?
large for dates = birth weight greater than 90th percentile for gestational age macrosomia = birth weight >4kg
40
When can large for dates and macrosomia be diagnosed?
After birth | cant estimate weight properly in utero
41
In macrosomia, baby is more at risk of birth complications such as ...
shoulder dystocia | birth injuries e.g. fractures, palsies
42
What is the absolute main cause of macrosomia
gestational DIABETES | can also be heavy parents but bit extreme like
43
Over half of polyhdramnios is idiopathic. Yeah?
yeah
44
Over half of polyhdramnios is idiopathic. But name 6 other causes of polydramnios. You can.
genetic/chromosomal abnormalities - trisomy 13,18,21 oes / duodenal atresia (stop foetus swallowing) macrosomia! maternal diabetes multiple preg! twin to twin transfusion syndrome foetal anaemia hydrops
45
No medical intervention is required in the majority of women with polyhydramnios. True or false?
true
46
If polydramnios picked up late, what symptom can the mum have?
breathlessness
47
On routine antenatal examination it is difficult to palpate foetal parts, and chart shows large for dates. Differential diagnosis? (x3)
polyhdramnios (yep) macrosomia multiple preg!
48
What is hydrops fetalis?
Abnormal accumulation of fluid in two or more foetal compartments. Including: ascites, pericardial effusion, pleural effusion, subcutaneous OEDEMA
49
What is the key cause of hydrops fetalis?
ANAEMIA e. g. Rhesus disease e. g. Parvovirus B19, other infections e. g. alpha thalassemia
50
Treatment for severe hydrops?
foetal blood transfusion
51
Treatment of polyhydramnios depends on underlying cause, mostly no intervention. What 2 interventions can be considered in severe polydramnios where maternal symptoms are severe?
INDOMETACIN - stop baby weeing AMNIOREDUCTION - drain amniotic fluid - risky when delivered, baby has to be check for oes. atresia by paediatrician passing NG tube
52
Polyhydramnios increases the risk of what three complications??
preterm labour malpresentation PPH
53
Which can the extra-fluid-compartments be in hydrops? (x4)
ascites, pericardial effusion, pleural effusion, subcutaneous OEDEMA
54
When do you use indomethacin
polyhydramnios - stop baby weeing | close PDA
55
the two types of PROM?
PROM | preterm PROM
56
define PROM
rupture of membranes at least 1 hr prior to the onset of labour
57
4 risk factors for PROM
``` genital infection polyhydramnios cervical insufficiency smoking in preg amniocentesis ```
58
what test is done in all cases of PROM?
HIGH VAGINAL SWAB
59
what test can be used to check its actually the waters and not just vaginal discharge
Actim-PROM
60
two bits of the foetal membranes are
chorion , amnion
61
suggest two infections that commonly cause PROM
GBS | BV
62
2 complications of PROM?
oligohydramnios | chorioamnionitis
63
management of PROM <34wks?
expectant.. | prophylactic erythromycin + corticosteroids
64
management of PROM >36wks?
induce + deliver if lasts >24hrs | IV penicillin during labour if GBS
65
management of PROM between 34 - 36wks?
induce!! | IV penicillin during labour if GBS

Obstetrics (6 decks)

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