Small for Dates Pregnancies

Question 1

a small for date baby is a baby below the _ centile in weight/abdo circumference

Answer 1

10th

Question 2

what can cause a baby to be small?

Answer 2

pre-term delivery
intrauterine growth restriction (IUGR)
small parents - physiologically small

Question 3

pre-term delivery is defined as delivery

Answer 3

37

Question 4

extreme preterm is defined as a baby born between _ and _ weeks

Answer 4

24 and 27+6 weeks

Question 5

very preterm is defined as a baby born between _ and _ weeks

Answer 5

28 and 31+6 weeks

Question 6

moderate to late preterm is defined as a baby born between _ and _ weeks

Answer 6

32 and 32+6 weeks

Question 7

how ocmmon is preterm delivery in the UK?

Answer 7

6-7%

Question 8

at what gestation does survival of the foetus reach 50% likelihood?

Answer 8

24 1/2 weeks

Question 9

causes of preterm birth?

Answer 9

infection
over distention
vascular
intercurrent ilness
cervical incompetence
idiopathic

Question 10

what illnesses during pregnancy can cause a preterm birth?

Answer 10

pyelonephritis
UTI
appendicitis
pneumonia

Question 11

define IUGR?

Answer 11

failure to achieve growth potential in utero

Question 12

define LBW?

Answer 12

birth weight <2.5kg

Question 13

how is asymmetrical IUGR different from symmetrical?

Answer 13

the head and abdomen are not proportional eg head is big, abdomen is small

Question 14

antenatal risk factors for an SGA foetus?

Answer 14

maternal age
smoking (>11)
low or high BMI
low fruit intake
pre-eclampsia
previous birth problems 
co-morbidities eg HT, diabetes

Question 15

1 single risk factor for SGA in pregnancy will prompt what investigations?

Answer 15

regular growth scanning

Question 16

at what weeks gestation do you scan to check for an SGA foetus?

Answer 16

28
32
36

Question 17

if you have 3 minor risk factors what investigations are done?

Answer 17

uterine artery doppler

scan at 34 weeks

Question 18

what growth investigation is done in all mothers regardless of risk factors?

Answer 18

24 weeks

Question 19

how is SGA diagnosed?

Answer 19

1. measure foetal abdominal circumference + head circumference +/- femur length to find out estimated foetal weight
2. amniotic fluid index (are they producing fluid) and doppler

Question 20

what does a uterine artery doppler indicate?

Answer 20

checks the resistance of blood flow to the baby (should be low even in diastole as forward flow to placenta should be constant)

Question 21

what maternal factors can cause an SGA baby?

Answer 21

lifestyle - smoking, alcohol, drugs
BMI
age
existing disease

Question 22

what placental factors can cause an SGA baby?

Answer 22

infarcts
abruption
eg from hypertension

Question 23

what foetal factors can cause an SGA baby?

Answer 23

infection eg rubella/CMV/toxoplasmosis
congenital anomalies eg absent kidneys
chromosomal abnormalities eg downs

Question 24

if a baby is small at 24 week scan what should you consider?

Answer 24

this could be a chromosomal abnormality (1 in 5)

Question 25

perinatal consequences of IUGR?

Answer 25

``` hypoglycaemia hypothermia polycythaemia hyperbilirubinaemia abnormal neurodevelopment ```

Question 26

clinical features of poor growth?

Answer 26

reduced foetal movements predisposing factors fundal height below expected reduced liquor

Question 27

how is foetal wellbeing assessed in an SGA baby?

Answer 27

assessment of growth cardiotocography (do this if you're noticing clinical features) biophysical assessment doppler USS

Question 28

what is a biophysical profile? what does it measure?

Answer 28

USS done for up to 20-30 mins | looks at movement, tone, foetal breathing movements, liquor volume

Question 29

when would you do a biophysical profile?

Answer 29

if you know the baby is small and you want to see if it responds well despite this

Question 30

what sign on doppler USS indicates a severe problem with the umbilical artery?

Answer 30

reverse end-diastolic flow (going under the line)

Question 31

when would you do an MCA and ductus venosus doppler?

Answer 31

32-37 weeks | normal umbilical artery doppler

Question 32

a positive MCA doppler increases what?

Answer 32

baby is shunting blood to the brain to preserve its organs

Question 33

a problematic MCA doppler means flow is __

Answer 33

high

Question 34

when would you consider earlier delivery by CS?

Answer 34

static growth | abnormal dopplers

Question 35

if both dopplers are abnormal, when would you delivery?

Answer 35

between 24 and 32 weeks

Question 36

if MCA doppler is abnormal but the umbilical artery doppler is fine, when would you deliver?

Answer 36

between 32 and 37 weeks

Question 37

when would you give steroids in pregnancy

Answer 37

up to 36 weeks gestation (2 doses 24hrs apart) to promote survival of the baby if youre planning a preterm delivery

Question 38

when would you give magnesium sulfate in pregnancy and why?

Answer 38

up to 32 weeks if planned preterm delivery; gives foetal neural protection