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Reproduction > Small for Dates > Flashcards

Small for Dates Flashcards

1
Q

why might a baby be small

A

pre term delivery
small for gestational age:
- IU/ fetal growth restriction
-constitutionally small

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2
Q

what are the categories of pre term births

A 
pre term= before 37 weeks 
moderate to late preterm= 32-36+6
very pre term= 28-31+6
extreme preterm= 24-27+6
(can have babies surviving 23 weeks, earliest ever is 21)
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3
Q

at what pre term date is survival >95% (same as term)

A

beyond 32 weeks

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4
Q

why is pre term birth important

A

survival and long term outcome worse the earlier the baby is born

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5
Q

why might a baby be born pre term

A

infection
over distention - multiple pregnancies, polyhydramnios
placental abruption
intercurrent illness- polynephritis/ UTI, appendicitis, pneumonia
cervical incompetence
idiopathic

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6
Q

what are the risk factors for pre term birth

A 
previous PTL (20%-40%)
multiple pregnancies (505)
uterine abnormalities 
age (teenagers)
parity (=0 or >5)
ethnicity 
poor socio-economic status 
smoking 
drugs (esp cocaine)
low BMI (<20)
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7
Q

what are the most common reasons for preterm birth

A

25% planned CS- severe pre eclampsia, kidney disease or poor fetal development
20% premature rupture of membranes
25% emergency - placental abruption, infection, eclampsia
40% unknown

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8
Q

what classifies as small for gestation age

A

EFW/ AB below the 10th centile (population or customised centiles)

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9
Q

define IUGR/ fetal growth restriction

A

failure to achieve growth potential

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10
Q

what classifies low birth weight

A

birth weight below 2.4kg regardless of gestation

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11
Q

what paths on growth centiles will IUGR and constitutionally small babies follow

A

IUGR will drop off centiles

constitutionally small babies will grow along lower centiles

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12
Q

what are the types of growth restrictions

A

symmetrical= small head and body= chromosomal abnormality/ in utero infection / environmental

asymmetrical= normal head and small body= suggests placental reasons- e,g, baby diverting blood to head over less vital organs = PET, placental causes, smoking

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13
Q

what are the minor risk factors for a SGA (Small gestational age) baby

A 
Maternal age >35 years
IVF pregnancy
Nulliparity
BMI <20
BMI 25-34.9
Smoker 1-10 cigarettes/day
Low fruit pre-pregnancy
Previous pre-eclampsia
Pregnancy interval <6 months
Pregnancy interval >60 months
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14
Q

what are the major risk factors for a SGA baby

A 
Maternal age >40 years
Smoker >11 cigarettes/day
Paternal SGA
Cocaine use
Daily vigorous exercise
Previous SGA baby
Previous stillbirth
Maternal SGA
Chronic hypertension
Diabetes with vascular disease
Renal impairment
Antiphospholipid syndrome
Heavy bleeding in pregnancy
Low PAPP-A
Fetal echogenic bowel
BMI >35
Known large fibroids
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15
Q

how do you identify SGA babies

A

maternal risk factors (1 major = USS’s from 26-28 weeks until 36 weeks= serial growth scans) (3 minor= growth scan at 34 weeks and if abnormal uterine doppler artery measurement at 20 weeks then monitored as if they had major risk factor)
antenatal screening

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16
Q

when do all women get a symphysial fundal height taken

A

24 weeks

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17
Q

what should you do if SFH below 10th centile

A

growth scan

18
Q

what do 2 or 3 SFH measurements that suggest slow of static growth require

A

a growth scan

19
Q

how do you diagnose SGA

A

measurement of fetal AC
combine with
head circumference +/- femur length
to get EFW

also use liquor volume or amniotic fluid index and dopplers

20
Q

what does liqour volume/ amniotic fluid index show in SGA

A

fluid around baby if normal suggests a healthy baby, if low suggests a sick baby and in the context of SGA may make you more suspicous that this baby is sick rather than constitutionally small

21
Q

what do doppler scans show

A

the blood flow to baby through the placenta and also how the baby is managing that blood flow within their own circulation

22
Q

what should be seen when measuring AC

A

stomach bubble
single rib
C shaped umbilical vein

23
Q

what are the three divisions for SGA causes

A

maternal
fetal
placental

24
Q

what maternal factors can cause SGA

A 
Lifestyle:
Smoking
Alcohol
Drugs
Height and weight
Age
Maternal disease e.g. hypertension
25
Q

what should uterine arteries be like in pregnancy

A

Pregnancy should be a low resistance state and the uterine arteries should become a low resistance vessel in the 2nd trimester with forward flow to the placenta even in diastole

26
Q

what can happen if there is resistance in both uterine arteries

A

at risk of SGA and hyeprtensive disease in pregnancy and pre eclampsia

27
Q

what usually causes resistance in the uterine arteries

A

abnormal placentation= so failure of the spiral artery invasion.

28
Q

what are the placental causes of SGA

A

Infarcts
Abruption
Often secondary to hypertension
(placenta not functioning properly= growth restriction)

29
Q

what are the fetal causes of SGA

A

infection- rubella, CMV, toxoplasma
congenital anomalies- absent kidneys
chromosomal abnormalities- downs syndrome

30
Q

what do you screen for when SGA is suspected early on

A

downs syndrome

SGA early on likely to be fetal factors

31
Q

what are the consequence of IUGR

A 
Antenatal / in labour: risk of hypoxia and or death
Post natal:
Hypoglycaemia
Effects of asphyxia
Hypothermia
Polycythaemia
Hyperbilirubinaemia
Abnormal neurodevelopment - cerebral palsy, developmental delay
32
Q

what are the clinical features of poor growth

A

predisposing factors
low SFH
reduced liquor
reduced fetal movements (important to tell mothers this so they can monitor movements)

33
Q

how do you asses fetal well being in SGA

A

assess growth (serial growth scans)
cardiotocography
biophysical assessment
doppler US

34
Q

what is a biophysical profile

A 
USS + CTG assessment that considers 
Movement
Tone
Fetal breathing movements
Liquor volume

scores out of ten:
8-10 satisfactory; 4-6 repeat; 0-2 deliver

35
Q

what does an umbilical arterial doppler measure

A

placental resistance to flow

pregnancy is a low resistance state and there should always be flow to the baby even in maternal diastole.

So a normal Doppler will show a constant flow of blood to baby even in diastole.

If there is developing resistance the Dopplers may deteriorate showing absent flow in diastole and the final step would be this flow becoming reversed so baby is not getting the nutrients they need from the placenta

36
Q

what is the primary tool for monitoring SGA and timing delivery

A

umbilical arterial doppler

37
Q

what can a MCA and Ductus Venosus Doppler show

A

if baby is diverting blood flow to its head to preserve vital functions at the expense of non vital organs

38
Q

when should you deliver a SGA baby

A

If all well = deliver by 37 weeks

Indications for considering earlier delivery by caesarean section:
Growth becomes static (IOL may be appropriate)
Abnormal umbilical artery Doppler
Normal umbilical artery Doppler with abnormal MCA between 32 and 37 weeks
Abnormal umbilical artery Doppler with abnormal ductus venosus Doppler between 24-32 weeks

39
Q

what drugs may be indicated if considering an earlier planned delivery

A

steroids- help lungs mature before 36 weeks

Magnesium sulphate which provides some fetal neuroprotection against cerbral palsy if delivery is planned before 32 weeks.

40
Q

what do you have to balance when timing SGA birth

A

the risks of prematurity and the potential of hypoxia in utero or still birth

41
Q

what is the role of the ductus venous in pregnancy

A

allow shunting of oxygenated blood to by pass the liver and move via IVC to oxygenate the brain.

42
Q

which is oxygenated- the umbilical artery or vein

A

vein

Reproduction (51 decks)

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