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Repro and Sexual Health > Small for dates pregnancy > Flashcards

Small for dates pregnancy Flashcards

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1
Q

What is a small baby?

A

Pre-term delivery
Small for gestational age; IUGR/FGR
Constitutionally small

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2
Q

What is IUGR/ FGR?

A

Intra-uterine growth restriction

Foetal growth restriction

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3
Q

What is a preterm delivery?

A

Before 37 weeks gestation

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4
Q

What is an extreme preterm delivery?

A

24-27+6 weeks

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5
Q

What is a very preterm delivery?

A

28-31+6 weeks

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6
Q

What is a moderate to late preterm?

A

32-36+6 weeks

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7
Q

How many babies in the UK are born preterm?

A

6-7%

1 in 10 pregnancies

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8
Q

When is a pregnancy “viable”?

A

24 weeks

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9
Q

Why is preterm birth important?

A 
23 weeks; 19% 
24 weeks; 40% 
25 weeks; 66% 
26 weeks; 77% 
Beyond 32 weeks >95% survival
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10
Q

What can cause preterm birth?

A 
Infection 
Multiples
Polyhydramnios
Placental abruption 
Pyelonephritis/ UTI
Appendicitis
Pneumonia
Cervical incompetence
Idiopathic
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11
Q

What is placental abruption?

A

The premature separation of the normal-sited placenta from the uterus

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12
Q

What are RF for preterm birth?

A 
Previous PTL
Multiples 
Uterine anomalies
Teenagers
Parity 0 or >5 
Ethnicity
Poor socio-economic status
Smoking
Drugs (cocaine) 
Low BMI (<20)
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13
Q

What are the reasons why preterm birth occur?

A

25% planned c/s; severe PET, kidney disease, poor foetal development
20% PROM
25% emergency; abruption, infection, eclampsia
40% unknown

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14
Q

What is the definition of a SGA foetus?

A

Estimated foetal weight or abdominal circumference below 10th centile

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15
Q

How is SGA plotted?

A

Population centiles

Customised centiles

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16
Q

What is a low birth weight?

A

Below 2.5kg (5 pounds 5) regardless of gestation

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17
Q

What is IUGR?

A

Failure to achieve growth potential

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18
Q

What is a worrying thing to see on centiles that points towards IUGR instead of constitutionally small?

A

If a baby stars on 50th centile and then drops centiles

However is a baby is on the 9th centile, but following their centile curve; they are small but not worrying

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19
Q

Why will you get asymmetric uterine growth restriction ?

A

Placental problems

Baby is diverting blood to the head to protect brain growth over less vital organs

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20
Q

Why will you get symmetric uterine growth restriction/

A

Chromosomal abnormality or in utero infection

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21
Q

How are SGA foetuses identified?

A

Antenatal RF

Screening during antenatal care

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22
Q

What are minor risk factors for SGA foetuses?

A 
Maternal age >35 
IVF 
Nulliparity
BMI <20 or 25-34.9 
Smoker 1-10 cigarettes/day 
Low fruit pre-pregnancy
Pregnancy interval <6 months of >60 months
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23
Q

What are major risk factors for SGA foetuses?

A 
Maternal age >40 
Smoker >11 cigarettes/ day 
Paternal, maternal or previous SGA
Cocaine use
Daily vigorous exercise
Previous stillbirth 
Chronic hypertx
Diabetes with vascular disease 
Renal impairement
APS
Heavy bleeding in pregnancy 
Low PAPP-A 
Foetal echogenic bowel 
BMI >35 
Large fibroids
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24
Q

What does a single major risk factor for SGA baby mean?

Study These Flashcards
A

Formally measure and monitor foetal growth by means of USS to estimate foetal size from 26-28 weeks and at regular intervals until 36 weeks
Serial growth scans

25
What does 3 minor risk factors for SGA mean?
Growth scan at 34 weeks and if abnormal uterine artery doppler measurement at 20 weeks then they would be monitored as if a major RF
26
When is symphyseal-fundal height first measured?
24 weeks then plotted on growth charts to identify if a formal scan is required for growth
27
What would indicate need for a formal scan from SFH at 24 weeks?
Single measurement below 10th centile | Serial measurements suggest slow/ static growth
28
How is SGA diagnosed on USS?
``` Measurement of foetal AC (10th c) Combine with head circumference +/- femur length to give EFW Liquor volume Amniotic fluid index Uterine artery doppler and MCA ```
29
What will liquor volume tell you about the health of an SGA baby?
Fluid around baby = good | If low; suggest a sick baby
30
What is the ideal ultrasound for measurement of AC?
Stomach bubble Single rib C-shaped umbilical vein
31
What doe customised growth charts take into account?
Maternal parity BMI Ethnicity
32
What chart is used in tayside for SGA?
International foetal growth standards; abdominal circumference
33
What maternal factors can result in a small baby?
``` Smoking Alcohol Drugs Height and weight Age Maternal disease; hypertx or renal disease ```
34
Will all women in tayside have a uterine artery doppler?
Yes; as part of 20 week scan
35
What is a bad sign in a uterine artery doppler?
Resistance within the artery | Reduced flow in diastole
36
What does resistance within the uterine artery put the mother and baby at risk for?
SGA PET BP issues
37
What is the proposed pathophysiology of uterine artery resistance?
Abnormal placentation | Failure of spiral artery invasion
38
What placental factors can result in a SGA foetus?
Infarcts Abruption 2ndary to hypertx
39
What foetal factors can result in SGA?
Infection; rubella, CMV, toxoplasmosis Congenital anomalies; absent kidneys Chromosomal abnormalities; DS
40
What should you think if the foetus is small before 24 weeks gestation?
Chromosomal abnormality
41
What are the antenatal/ labour risks with IUGR?
Hypoxia | Stillbirth
42
What are the postnatal consequences of IUGR?
``` Hypoglycemia Asphyxia Hypothermia Polycythaemia Hyperbilirubinemia CP ```
43
What are the clinical features of poor growth in utero?
Predisposing factors Fundal height reduced Reduced liquor Reduced foetal movements
44
How should foetal wellbeing be assessed?
Assessment of growth Cardiotocography Biophysical assessment Doppler ultrasound
45
What babies qualify for serial growth scans?
Any baby with AC or EFW below 10th centile
46
What is a biophysical assessment?
USS assessment | Considers; movement, tone, foetal breathing movements, liquor volume
47
What is the primary tool for monitoring SGA babies and timing of delivery?
Umbilical doppler assessment | Gives a measurement of placental resistance to blood flow
48
Why is a MCA doppler done on foetuses?
If MCA is low resistance; suggests the baby is diverting blood to its head to preserve vital functions at expense of non-vital organs
49
When are SGA babies delivered if no complications?
37 weeks
50
What are indications for considering an earlier delivery in SGA foetuses?
Growth becomes static; IOL 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
51
What needs to be given to the mother if a preterm delivery is planned?
Steroids; to increase lung maturity and reduce NEC | Magnesium sulphate; 4 hours pre-delivery to provide foetal neural protection
52
At what stages of gestation will steroids and magnesium sulphate be given in a pre-planned preterm delivery?
<36 weeks; steroids | <32 weeks; magnesium sulphate
53
What is the balance between in preterm delivery in a SGA infant?
Risks of prematurity | Potential of hypoxia in utero or still birth
54
What causes a symmetrical IUGR?
Congenital Chromosomal Intrauterine infection Environemental
55
What causes an asymmetrical IUGR?
PET Placental causes Smoking
56
What will occur to the resistance in the ductus venosus and MCA in a distressed/ hypoxic/ acidotic foetus?
Ductus venosus; pulsatile and increased resistance | MCA; decreased resistance
57
Does the umbilical artery have deoxygenated or oxygenated blood?
Umbilical artery = deoxygenated | Umbilical vein = oxygenated
58
What is the role of the ductus venosus in the foetal circulation?
Shunts oxygenated blood past the liver to the IVC to oxygenate the brain

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