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A. Block C Paediatrics > Growth Restriction > Flashcards

Growth Restriction Flashcards

1
Q

Match the following with the dates:

Extremely preterm
Very preterm
Moderate to late preterm

28 to < 32 weeks
< 28 weeks
32 to 37 weeks

A

Extremely preterm = < 28 weeks
Very preterm = 28 to < 32 weeks
Moderate to late preterm = 32 to 37 weeks

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2
Q

What is defined as a very low birth weight?

1 - <500g
2 - <1000g
3 - <1500g
4 - <2000g

A

2 - <1000g

Very low birth weight = <1500g
Low birth weight = < 2500g

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3
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential. What is the primary reason for this?

1 - congenital defects
2 - placenta dysfunction
3 - trauma
4 - infection

A

2 - placenta dysfunction

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4
Q

What is small for gestational age (SGA)?

A
  • term used to describe a baby who is smaller than the usual amount for the number of weeks of pregnancy
  • BUT not foetal growth restriction
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5
Q

Small for gestational age (SGA) is a term used to describe a baby who is smaller than the usual amount for the number of weeks of pregnancy, generally those in the <10 centile (NOT foetal growth restrction). What are the 2 methods commonly used to assess if the baby is SGA?

1 - serum levels of foetal HMB
2 - estimated foetal weight
3 - abdominal circumference
4 - bilirubin levels

A

2 - estimated foetal weight
3 - abdominal circumference

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6
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. What are the 2 types of FGR?

1 - symmetrical
2 - asymmetrical
3 - age based FGR
4 - geneder based FGR

A

1 - symmetrical
2 - asymmetrical

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7
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. There are 2 types of FGR, symmetrical and asymmetrical. What is symmetrical and asymmetrical FGR?

A
  • symmetrical = small head and small abdomen (BUT everything is symmetrical)
  • asymmetrical = normal head and small abdomen (NOT symmetrical)
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8
Q

Which of the following measurews is NOT typically used to measure foetal growth restriction (FGR)?

1 - size
2 - growth
3 - type
4 - gender

A

4 - gender

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9
Q

Assessing the size of the baby in pregnancy is crucial to assess if the baby has a small gestational age (SGA). What is the definition from the WHO on if a baby is SGA?

1 - <500 grams or 0.5kg at birth
2 - <1000 grams or 2.0kg at birth
3 - <2500 grams or 2.5kg at birth
4 - <5000 grams or 6.0kg at birth

A

3 - <2500 grams or 2.5kg at birth

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10
Q

When assessing the growth of a foetus during pregnancy, why is it important to perform multiple observations?

A
  • a dynamic and changing process
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11
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. There are 2 types of FGR, symmetrical and asymmetrical:

  • symmetrical = small head and small abdomen (BUT everything is symmetrical)
  • asymmetrical = normal head and small abdomen (NOT symmetrical)

Which of the following is NOT a common causes for symmetrical FGR?

1 - congenital/chromosomal abnormalities
2 - intrauterine infections
3 - pre-eclampsia
4 - environmental factors

A

3 - pre-eclampsia

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12
Q

Foetal growth restriction (FGR) is the failure of the foetus to achieve its predetermined growth potential, which is primarily caused by placenta dysfunction. There are 2 types of FGR, symmetrical and asymmetrical:

  • symmetrical = small head and small abdomen (BUT everything is symmetrical)
  • asymmetrical = normal head and small abdomen (NOT symmetrical)

What is the most common causes for asymmetrical FGR?

1 - congenital/chromosomal abnormalities
2 - intrauterine infections
3 - pathology associated with pregnancy (delayed onset)
4 - environmental factors

A

3 - pathology associated with pregnancy (delayed onset)

  • pre-eclampsia (high BP and coagulation issues), essential hypertension
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13
Q

Which of the following is NOT a risk factor associated with an increased risk of small gestational age?

1 - asian/Indian ethnicity
2 - multiple pregnancy
3 - low BMI and maternal weight gain
4 - nulliparity (1st pregnancy)
5 - daily vigorous exercise
6 - maternal exposure to caffeine
7 - one baby at one time

A

2 - multiple pregnancy

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14
Q

A woman attends her GP for pre-conception counselling because the first child was born small for gestational age (SGA). What intervention is significant in reducing risk of SGA foetus in those with risk factors?

1 - Progesterone supplement
2 - Dietary modification
3 - Calcium supplements
4 - Smoking cessation
5 - Anti platelets

A

4 - Smoking cessation

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15
Q

In non-pregnant women there are a number of different blood vessels that supply the uterus. However, once the placenta has formed, angiogenesis begins and 3 types of arteries develop within the placenta. Which of the following is NOT one of these 3 blood vessels called?

1 - hairline arteries
2 - arcuate arteries
3 - uterine arteries
4 - spiral arteries

A

1 - hairline arteries

  • uterine arteries = uterine
  • spiral arteries = endometrium (generally lost during periods)
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16
Q

What cell that is derived from the blastocyst forms the placenta?

1 - trophoblasts
2 - oocyte
3 - blastocyts
4 - cytotrophoblast

A
17
Q

What is the most common finding in stillborn babies?

1 - congenital abnormalities
2 - foetal growth restriction
3 - pre-eclampsia
4 - pregnancy of unknown origin

A

2 - foetal growth restriction

18
Q

If a baby is born and has foetal growth restrictions what are some of the acute conditions they may develop?

1 - necrotising enterocolitis
2 - hypoxic brain injury
3 - respiratory support
4 - chronic lung disease
5- retinopathy
6 - all of the above

A

6 - all of the above

19
Q

If a baby is born and has foetal growth restrictions what are some of the chronic conditions they may develop?

1 - metabolic electrolyte imbalance
2 - failure to thrive
3 - learning difficulties
4 - short stature
5 - cerebral palsy
6 - mental handicap
7 - all of the above

A

7 - all of the above

20
Q

What is the gold standard for antenatal care that is used to identify foetal growth restriction?

1 - alpha-fetoprotein
2 - abdominal palpatation
3 - human chorionic gonadotrophin
4 - serial ultrasound with doppler scans

A

4 - serial ultrasound with doppler scans

Abdominal palpatation has a sensitivity of 30%, so not great as can be difficult in late pregnancy

21
Q

A measurement from the symphysis to the fundus, provides fundal height with abdominal girth. What are the detection rates for this in detecting foetal growth restriction?

1 - 20-80% detection rate
2 - 1-2% detection rate
3 - 100% detection rate
4 - not used anymore

A

1 - 20-80% detection rate
- does not improve perinatal outcome

22
Q

When assessing foetal well being, in addition to imaging modalities, we can determine the foetus biophysical profile. Which of the following measurements are included in this profile?

1- cardiotocography (HR and uterine contractions)
2 - respiratory rate
3 - foetal body movements (ultrasound)
4 - liquor volume (amniotic fluid volume)
5 - foetal growth
6 - foetal breathing movements (ultrasound)

A

2 - respiratory rate

23
Q

In a normal pregnancy, does the blood flowing from the mother through the umbilical cord blood vessels (umbiliical artery and vein) have any resistance?

A
  • no

- placenta acts as a sponge, from there it delivers oxygenated blood to the foetus

24
Q

What is placenta infarction?

1 - rupture of placenta
2 - infection of placenta
3 - interruption of blood supply to a part of the placenta
4 - all of the above

A

3 - interruption of blood supply to a part of the placenta

  • normally in the umbilical artery
  • lack of blood causes hypoxia and ischaemia
  • cells of the placenta can die
25
Q

In a pregnancy where there is placenta infarction, which is interruption of blood supply to a part of the placenta, causing its cells to die, is there a resistance to blood flow to the foetus?

A
  • Yes
  • placenta acts as a wall
  • blood is unable to reach the foetus and reflects back along the umbilical artery
26
Q

What method can be used to detect blood flow velocity in foetal and placenta vessels?

1 - Ultrasound doppler
2 - CT scan
3 - X-ray
4 - MRI

A

1 - Ultrasound doppler

Reduced end diastolic flow suggests placenta has high resistance and is failing and baby may be at risk of hypoxia

27
Q

Does the growth chart show foetal growth restriction or small gestational age?

A
  • small gestational age
  • plot is consistent and does not move between deciles
28
Q

Does the growth chart show foetal restriction growth or small gestational age?

A
  • foetal growth restriction
  • Serial ultrasound scans provide this information
  • begins in 9th percentile, but drop between deciles
29
Q

In the growth chart below, we can see that the top figure demonstrates a small gestational baby and the bottom chart shows a foetal growth restriction. Of the 2 which baby may need to be delivered prematurely?

A
  • foetal growth restriction
  • the placenta may be failing the baby is malnourished and/or hypoxic
30
Q

In asymmetrical foetal growth restriction there is generally a larger head and/or organs compared to the abdomen, as seen in the image below. Typically caused by pathology associated with pregnancy (delayed onset), such as pre-eclampsia (high BP and coagulation issues), essential hypertension. Why do some organs develop more than others?

1 - some organs develop quicker
2 - some organs dont need as much oxygen
3 - preferantial direction of oxygen
4 - all of the above

A

3 - preferantial direction of oxygen
- the body adapts to lack of nutrient and hypoxia
- for example the brain sparing effect as the foetus redistributes blood to the more critical tissues (liver, kidneys etc…)

31
Q

In the brain sparing effect that we observe in the asymmetrical foetal growth restriction, is the head circumference (HC) or abdomen circumference (AC) normally bigger?

A
  • normally head is bigger
  • AC < HC
32
Q

What is Pregnancy Associated Plasma Protein-A (PAPP-A)?

1 - hormone secreted by ovaries to help pregnancy
2 - a hormone that made by the placenta (afterbirth) in pregnancy
3 - hormome secreted by hypothalamus to help with milk production
4 - hormone secreted by baby to stimulate increased insulin sensitivity

A

2 - a hormone that made by the placenta (afterbirth) in pregnancy
- secreted by the placenta to maintain placenta development

33
Q

Pregnancy Associated Plasma Protein-A (PAPP-A) is a hormone that made by the placenta (afterbirth) in pregnancy secreted by the placenta to maintain placenta development. Do low levels of this indicate foetal growth restriction or small gestational age?

A
  • foetal growth restriction
34
Q

What is the Barkers hypothesis?

A
  • adverse nutrition in early life including foetal growth restriction can increase risk of metabolic syndrome (obesity, diabetes, insulin insensitivity, hypertension, hyperlipidemia, coronary heart disease)
35
Q

If a baby is detected as having an abnormal blood flow to the placenta using ultrasound doppler, what gestation should they be delivered?

1 - <28 weeks
2 - <32 weeks
3 - <36 weeks
4 - <40 weeks

A

2 <32 weeks
- better to be in NICU than in a uterus with restricted blood flow to the placenta

36
Q

You are counselling a 16 week gestation primiparous woman regarding her results which suggest a low PAPP-A level.Which is the only form of surveillance that, when used alone, has been shown to reduce perinatal morbidity and mortality in a high-risk population?

1 - Foetal movement monitoring
2 - USS assessment of liquor volume
3 - CTG cardiotocography
4 - Biophysical profile scoring
5 - Umbilical artery doppler

A

5 - Umbilical artery doppler

A. Block C Paediatrics (50 decks)

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