REPRO > Small dates for pregn. > Flashcards

Small dates for pregn. Flashcards

(45 cards)

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1
Q

Why small baby?

A
  • pre- term delivery
    Small for gestational age:
    1. IUGR/FGR
    2. constitutionally small
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2
Q

When is a preterm delivery ?

A

<37 wks
Extreme pre-term? 24-27+6
Very pre-term? 28-31+6
Moderate to late: 32-36+6

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3
Q

What is the survival rate of a 23 weeks birth?

A

20% chance of survival

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4
Q

What is the survival for a bby born beyond 32 weeks vs 26 weeks?

A

> 95%

26 weeks- 77%

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5
Q

Etiology of pre-term births?

A

Infection

‘Over distension’:
-Multiple
=Polyhydramnios

Vascular:
-Placental abruption

Intercurrent illness:

  • Pyelonephritis / UTI
  • Appendicitis
  • Pneumonia

Cervical Incompetence
Idiopathic

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6
Q

How to label a SGA fetus?

A
  • fetal weight or abdominal circumference is BELOW the 10th centile
  • IUGR/ FGR
  • LBW (below 2.5 kg) —-regardless of gestation
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7
Q

What can growth restriction be divided into?

A

Symmetrical: small head and small body

Asymp: normal size head and small body

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8
Q

Why are uterine artery dopplers performed?

A
  • resistance of uterine artery is measured at 20 weeks

- —–presence of resisytance: HIGH RISK OF PRE-ECLAMPSIA and SMALL bby

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9
Q

Why are uterine artery dopplers performed?

A
  • —–presence of resistance

- chewck the risk of hypertensive disease in pregnancy and risk of SGA

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10
Q

Fetal factors for small birth baby?

A
  • infection (Rubella, CMV, Toxoplasmosis)
  • congenital anomalies (absent kidneys)
  • chromosomal abnormalities (Down $)
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11
Q

What are the clinical features of Poor growth?

A
  • reduced fetal movements
  • reduced SFH than expects
  • reduced liquor
  • predisposing factors
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12
Q

What is referred to as Biophysical profile?

A
  • ## ultrasound assessment of the baby (combined with CTG)
  • baby is scored on the presence of MOVEMENT/ TONE/ fetal breathing/ Liquor volume

—–score out of 10

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13
Q

What does the uterine artery doppler demonstrate, if there is developing HIGH resistance to the fetus?

A
  • points where the blood flow is REVERSED; so baby is not recieving as much blood (just a little)
  • absent flow during diastole (should NOT occur)
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14
Q

Any medications given to preterm babies?

A
  • steroid: to promote fetal LUNG maturity
    (if delivery is before 36 wks)
  • Magnesium sulphate (fetal neuroprotection against cerebral palsy, if before 32 weeks)
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15
Q

What are the risk factors for a pre-term baby?

A
  1. previous PTL (40% if 2x)
  2. Multiple
  3. Uterine anomalies
  4. Age (teenagers)
  5. Parity (=0 or >5)
  6. ehtnicity
  7. poor socio-econommic statur
  8. smoking
  9. Drugs (cocaine)
  10. Low BMI (<20)
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16
Q

Why do multiple pregnancies at once, increase the risk of a preterm birth?

A
  • due to overdistension of the uterus

- complications may also contribute

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17
Q

25% of pre-term birth is planned c-section. Why plan a c-section?

A
  • severe pre-eclampsia
  • kidney disease
  • poor fetal development
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18
Q

MAjority of pre-term is d/t this…..

A

UNKNOWN CAUSE (40%)

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19
Q

25% of pre-term birth is d/t an emergency event.

Study These Flashcards
A
  • placental abruption
  • infection
  • eclampsia (seizures)
20
Q

What is considered to be small for gestational age ?

Study These Flashcards
A
  • EFW or AC is below the 10th centile (in the popn centile and the customised centiles)
21
Q

What is the difference between IUGR and SGA?

Study These Flashcards
A
  • IUGR: bby starts on 50th centile and then cross centiles ending up on 20th over time = FAILURE to achieve true growth potential
  • SGA: may grow on the 9th centile but they continue to follow their centile curve
22
Q

Why may symmetrical growth restriction occur vs asymmetrical GR?

Study These Flashcards
A
  • possible chromosomal abnormality
  • in utero infection
  • congenital
  • environmental

Asymm: placental reasons (baby is diverting blood to HEAD - to protect brain growth)
- smoking

23
Q

Major risk factors for SGA baby?

Study These Flashcards
A

oldmom/smoker/parental SGA /cocaine/Daily vigorous exercise/previous-stillbirth,SGA/diabetes/renal impariment/APS/heavy bleeding in pregnancy/low PAPP-A/ BMI>35/ fetal echogenic bowel

24
Q

When is a growth scan indicated for a pregnancy?

Study These Flashcards
A
  • after a single measurement (even 2 or 3) plots below the 10th centile= suggests slow/ static growth
25
How to diagnose SGA?
- measuring fetal abdominal circumference - Combine with Head circumference +/- femur length to give EFW - Additional info from the scan= liquor volum/ amniotic fluid index-fluid around baby if low (sick baby)/ dopplers
26
Why may there be high resistance in the uterine artery?
- d.t abnormal placentation; failure of spiral artery invasion
27
Once the fetal weight is estimated, what is then done?
- value is plotted on customized growth charts - ---guides you; whether or not the bby is at risk of SGA - -----with serial scans can see if the baby is following ITS PERCENTILE- determines if its at
28
Maternal factors that cause SGA?
- Smoking/alcohol/drugs - heightand weight - age - maternal disease (hypertension)
29
When do the ladies have their uterine artery dopplers performed?
- at their 20 weeks scan
30
What are placental factors for SGA?
- infarctions - abruption - IIary to hypertension ----abnormally functioning placenta results in growth restriction or FAILURE
31
If SGA/FGR is suspected from early on in the pregnancy; what is thought to be the cause?
- chromosomal abnormality
32
What are the postnatal consequences of IUGR?
- hypoglycemia - effects of asphyxia - hypothermia - polycythaemia - hyperbilirubinemia - abnormal neurodevelopment
33
Antenatal consequence of IUGR baby?
- risk of HYPOXIA and or DEATH
34
Why is it important to identify a SGA baby ?
- risk of still birth | - following delivery of these babies; additional support in the neonatal unit may be needed
35
Any affect on the SGA baby's adult hood?
- ongoing support in cases of cerebral palsy or developmental delay
36
What combination of measures help assess the fetal well-being?
- assessment of growth - cardiotocography - biophysical assessment - doppler usg
37
Which baby will have serial scans for growth?
- any baby with AC or EFW below the 10th centile
38
Can blood flow within the baby be picked up?
- yes | - mainly in its middle cerebral artery and the ductus venous flow
39
How may a change in the MCA resistance suggest fetal compromise?
- if MCA was to become LOW resistance vessel | - ---mean baby is diverting blood flow to its head to preserve the vital functions at the EXPENSE of non-vital organs
40
Timing for a smooth pregnancy= 37 weeks. | What are indications for earlier delivery?
- growth becomes static (IOL 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
41
Babies under which particular centile are at a higher risk?
- those below the 3rd centile | - -----babies between 3rd and 10th are more likely to be constitutionally small
42
What advise is given from our College about the delivery of SGA babies?
---should be delivered at around 37 weeks REGARDLESS of growth trajectory
43
What is the usual resistance of the umbilical artery?
should be LOW ----when compromised it is HIGH; flow becomes absent and reversed in diastole ----> MCA decr. resistance to maintain fetal blood flow to the brain
44
What is an indicator of the baby becoming acidotic?
--->when ductus venous doppler becomes pulsatile and INCREASES in resistance
45
What does the ductus venous do?
- resp. for shunting oxygenated blood from the placenta AWAY from the liver to the IVC---> Brain
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