Small and Large Births

Question 1

What is defined as preterm delivery?

Answer 1

Delivery before 37 weeks gestation

Question 2

Give some potential causes for preterm birth

Answer 2

Infection
Over distention
Placental abruption
Illness (pyelonephritis/appendicitis etc.)
Cervical incompetence

Question 3

Give some risk factors for preterm birth

Answer 3

Previous preterm delivery
Multiple pregnancy
Young age
Smoking
Low BMI
Cocaine use

Question 4

What is a small for gestational age foetus?

Answer 4

When estimated foetal weight/abdo circumference is below 10th centile

Question 5

What is defined as a low birth weight?

Answer 5

Birth weight below 2.5kg

Question 6

Give some risk factors for SGA foetus

Answer 6

Older maternal age
Smoker
Previous SGA
Hypertension
High BMI
Pre-eclampsia

Question 7

How is SGA screened for during antenatal care?

Answer 7

Measurement of symphysial-fundal height from 24 weeks

Question 8

How is SGA diagnosed?

Answer 8

Measuring foetal abdo circumference and combining with head circumference +/- femur length

Question 9

Give some maternal factors that can lead to SGA

Answer 9

Smoking/alcohol/drugs
Height and weight
Young age

Question 10

Give some placental factors that can lead to SGA

Answer 10

Infarcts

Abruption

Question 11

Give some foetal factors that can lead to SGA

Answer 11

Infection (rubella/CMV/toxoplasma)
Congenital abnormalities
Chromosomal abnormalities

Question 12

What scan can be done to assess the umbilical artery?

Answer 12

Doppler USS

Question 13

Give some indications for earlier delivery by C-section

Answer 13

Growth becomes static

Abnormal umbilical artery USS

Question 14

What medical management should be considered if planning early delivery?

Answer 14

Steroids

Magnesium sulfate

Question 15

What is defined as large for dates?

Answer 15

Symphyseal-fundal height >2cm for gestational age

Question 16

What is foetal macrosomia?

Answer 16

When USS estimated foetal weight >90th centile

Question 17

What is polyhydramnios?

Answer 17

Excess amniotic fluid (AFI >25cm)

Question 18

Give some causes of polyhydramnios

Answer 18

Maternal diabetes
Foetal anomaly
Monochorionic twin pregnancy
Viral infection

Question 19

Give some clinical features of polyhydramnios

Answer 19

Abdo discomfort
Preterm labour
Cord prolapse
Tense shiny abdomen
Inability to feel foetal parts

Question 20

What investigation is done to diagnose polyhydramnios?

Answer 20

USS

Question 21

Give some risks of polyhydramnios during labour

Answer 21

Malpresentation

Cord prolapse

Question 22

Give some risks for multiple pregnancy

Answer 22

Assisted conception
African race
FHx
Increased maternal age
Increased parity
Tall mothers

Question 23

What is chorionicity?

Answer 23

The number of placentas present (i.e. monochorionic = 1)

Question 24

What investigation is done to confirm chorionicity?

Answer 24

USS

Question 25

Give some clinical features of multiple pregnancy

Answer 25

Exaggerated pregnancy symptoms (HG) High AFP Large for dates uterus

Question 26

Give some foetal complications of multiple pregnancy

Answer 26

Higher perinatal mortality Congenital anomalies Pre-term birth Cerebral palsy

Question 27

Give some maternal complications of multiple pregnancy

Answer 27

Hyperemesis gravidarum Anaemia Pre-eclampsia Preterm labour

Question 28

What medications are used in the management of multiple pregnancy?

Answer 28

Iron supplementation Low dose aspirin Folate

Question 29

How often are USS carried out in monochorionic and dichorionic pregnancies?

Answer 29

MC - 2 weekly from 16/40 | DC - 4 weekly

Question 30

Give some complications of a monochorionic twin pregnancy

Answer 30

Single foetal death Selective growth restriction Twin anaemia-polycythaemia sequency

Question 31

What is gestational diabetes?

Answer 31

When carbohydrate intolerance results in hyperglycaemia with first recognition during pregnancy

Question 32

In a patient with type 1/2 diabetes - what is the aim for HbA1c before starting pregnancy?

Answer 32

48mmol/mol

Question 33

Give some risk factors for gestational diabetes

Answer 33

``` Previous GDM BMI >30 Previous big baby Polyhydramnios Glycosuria ```

Question 34

Why does gestational diabetes occur?

Answer 34

There is overgrowth of insulin sensitive tissues and placental hormones cause insulin resistance

Question 35

What values are diagnostic for gestational diabetes on an oral glucose tolerance test?

Answer 35

Fasting > 5.1 mmol/l | 2 hour > 8.5 mmol/l

Question 36

What glycaemic targets are aimed for during pregnancy?

Answer 36

Fasting = 3.5-5.5 mmol/l | 1 hour = <7.8 mmol/l

Question 37

When is timing of delivery aimed for in patients with gestational diabetes?

Answer 37

Insulin treatment = 38 weeks Metformin = 39-40 weeks Diet alone = 40-41 weeks

Question 38

What supplement should be given to diabetic women in pregnancy?

Answer 38

Folate 5mg