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Flashcards in Fetal growth & nutrition Deck (17)
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1

Outline the embryo& fetal growth patterns

1.) stage I (hyperplasia): Rapid mitosis and increase of DNA content; 4-20weeks
2.) Stage II(hyperplasia& hypertrophy): Declining mitosis with increase in cell size; 20-28 weeks
3.) Stage III (hypertrophy): rapid increase in cell size;, rapid accumulation of fat,muscle, CT; 28-40weeks

2

When is the greatest fetal weight increase

3rd trimester

3

What landmarks does the crown-rump length(CRL) measurement involve

-Top of head( crown)
-Bottom of buttocks (rump)
-CRL may be used to date pregnancy

4

Describe the ultrasound assessment of 1st trimester

-Routine scan approx 12 weeks from last menstrual period
-Viability
-CRL measurement
-used to date pregnancy
-If CRL>/= 84.1mm=date by head circumference
-Also offer screening for trisomies

5

Describe the ultrasound assessment of 2nd trimester

-Routine anomaly scan
-18-20weeks
-Assess fetal growth, fetal anomalies, placental site
4 standard growth measurements; fetal growth/biometry:
-Head circumference
-Bi-parietal diameter
-Abdominal circumference
-Femur length
Combine to estimate fetal weight

6

What is the symphysial fundal height (SFH)?

-Fundus (variable) to pubic symphysis( fixed)

7

If there are concerns about growth another scan can be taken in 2nd/3rd trimester. What does this involve?

-Biometry (HC, BPD, AC, FL)
-Amniotic fluid index
-Umbilical artery doppler

8

What are the risk factors for a small gestational age ( SGA) fetus

-Current/demographic risks: small petite woman
-Previous pregnancy risks: previous SGA fetus or FGR seen
-Maternal medical history: hypertension, diabetes, chronic kidney disease, pre-eclampsia
-Current pregnancy complications: e.g pre-eclampsia

9

Outline fetal growth in high risk pregnancy due to twins

1.) Dichorionic (two placentae)
-lower risk of problems
-scan every 4 weeks
2.) Monochorionic ( shared placenta)
-higher risk of problems
-scan every 2 weeks
-selective IUGR
-Twin-to-twin-transfusion

10

Outline the principles of SGA pregnancy management

Screen and identify at risk pregnancies
-Aspirin if low PAPP-A/ risk of PET
-Uterine artery dopplers
Monitor with scans
-If abnormal growth-increase frequency of scans
-If FGR/functional concerns- consider early delivery (steroids)
-If SGA- consider induction at 37week

11

What does it mean when a baby is large for gestational age

Estimated fetal weight >90th centile
-Macrosomia
-Birth weight> 4kg
(approx 10% of babies)

12

What does it mean when a baby is small for gestational age

SGA
1.) infant: birth weight< 10th centile
2.) fetus: EFW or AC< 10th centile
Severe SGA
-fetus: EFW or AC< 3rd centile
-higher chance of FGR

13

What are the risk factors for LGA?

-Constitutional ( large/tall parents)
-Raised BMI
-Previous LGA baby
-diabetes : type 1,2 & gestational

14

Outline the morbidity& mortality for a LGA fetus

1.) perinatal complications
-shoulder dystocia
-brachial plexus nerve injury
-fractured humerus/clavicle
-birth asphyxia/still birth
2.) If diabetic pregnancy
-hypoglycaemia
3.) Maternal complications; increased risk of:
-C-section/ instrumental
-perineal trauma/tears if vaginal birth
-postpartum haemorrhage

15

What does it mean if a fetus is growth restricted

Fetal growth restriction( FGR)/ in-utero growth restriction ( IUGR)
-Pathological restriction of genetic growth potential
-may have evidence of fetal compromise ( abnormal AFI- amniotic fluid index /dopplers)

16

outline the morbidity& mortality of FGR babies

increased perinatal complications
-stillbirth
-seizures
-Apgar score< 4
-cord Ph= 7
-admission to intensive care
-hypothermia
-hypoglycaemia

17

What is an APGAR score?

-Appearance, Pulse, Grimace, Activity, and Respiration
-A test given to newborns soon after birth.
-Checks a baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.
-The test is usually given twice: once at 1 minute after birth, and again at 5 minutes after birth.
-Each is scored on a scale of 0 to 2, with 2 being the best score: