Growth monitoring, stillbirth Flashcards Preview

Stage 3: EJR - Obstetrics > Growth monitoring, stillbirth > Flashcards

Flashcards in Growth monitoring, stillbirth Deck (21):
1

Foetal indications for growth scans (current pregnancy)

• First fundal height measurements at 26-28w below 10th centile
• Static/ slow/ excessive growth
• Suspected polyhydramnios/ oligohydramnios
• Suspected/ confirmed foetal anomaly
• Multiple pregnancy

2

Maternal indications for growth scans (current pregnancy)

• Maternal smoking (including smoking while trying to get pregnant)
• Late booker (20+ weeks gestation)
• Substance misuse

3

Past obstetric history indications for growth scans

• Previous unexplained stillbirth
• Previous birthweight <10th centile

4

Past gynae history indications for growth scans

• Pre-existing diabetes
• Chronic illness
• Uterine fibroids 6+ cm
• BMI >35

5

What 3 measurements are made in a foetal growth scan

1. head circumference
2. abdominal circumference
3. femur length

6

Components of customised growth chart

• Mum’s ethnicity
• Mum’s weight and height
• Parity

Note: does NOT include gender

7

Definition of Small for Gestational Age

Weight of foetus <10th centile for its gestation

8

Definition of IUGR

Foetus failed to reach growth potential (based on customised growth chart)

9

Non-pathological causes of a small baby

• Low maternal height & weight
• Asian ethnicity
• Nulliparous
• Female foetus

10

Pathological causes of IUGR

• Maternal renal, autoimmune disease, pre-eclampsia
• Multiple pregnancy
• Smoking, drug usage
• Infection eg CMV
• Extreme exercise, malnutrition
• Congenital abnormalities

11

Which type of scan is best for assessing placental dysfunction after 34 weeks

Foetal MCA Doppler

12

How often are growth scans in SGA-only baby

2-3 weekly intervals

13

How often are growth scans in IUGR baby

Scan at least 2x a week.
Daily CTG if <32 weeks

If absent end diastolic flow seen, admit mum to hospital. give steroids.

14

Definition of stillbirth

Foetus delivered after 24weeks with no signs of life

15

Risk factors for stillbirth

• IUGR, particularly due to smoking, multiple pregnancy
• Congenital abnormalities
• Diabetes, autoimmune disease, sickle cell disease, renal disease
• GDM, pre-eclampsia leading to placental insufficiency
• Infection
• Placental abruption

16

When would you do an umbilical artery doppler

All growth scans
(marker of foetal wellbeing at the time)

17

When would you do a uterine artery doppler

Screening tool at 23 weeks
(if risk of IUGR)

18

When would you do a foetal MCA doppler

Suspected foetal ANAEMIA eg
• Maternal infection
• Foetal hydrops

19

Feature of Potter syndrome (complication of oligohydramnios)

1. Pulmonary hypoplasia
2. Limb deformities
3. Characteristic facial features (flat nose, low-set ears)

20

What might an abnormal uterine artery doppler indicate

1. Pre-eclampsia
2. IUGR
3. Placental abruption
4. Adverse neonatal outcomes in early 3rd trimester

21

What might low PAPP-A indicate

1. Chromosomal abnormalities
2. High risk of IUGR
3. High risk of Placental abruption
4. High risk of Stillbirth