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Flashcards in Small & Large Births Deck (41)
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1
Q

What are the 2 main causes for a small baby?

A

Pre-term delivery

Small for gestational age due to intrauterine growth restriction (IUGR) or simply constitutionally small!

2
Q

How is a birth defined as preterm?

A

Delivery between 24-36 weeks gestation

3
Q

List some causes of preterm birth

A

Infection
Overdistention (multiple pregnancy, polyhydraminos)
Placental abruption
Cervical incompetence
Intercurrent illness (UTI, appendicitis, pneumonia)
Idiopathic

4
Q

How is a baby defined as being small for gestational age? What is IUGR? What is LBW?

A

Estimated fetal weight or abdominal circumference below 10th centile
Failure to achieve growth potential
Birth weight below 2.5kg regardless of gestation

5
Q

What maternal factors cause poor growth of a foetus?

A

Lifestyle: smoking, drugs, alcohol
BMI 19 or less
Extremes of age
Disease: hypertension (placental infarcts)

6
Q

What foetal factors cause poor growth of a foetus?

A

Infection: rubella, CMV
Congenital anomalies
Chromosomal abnormality

7
Q

What are the consequences to the foetus if there is growth restriction?

A
Hypoxia
Hypoglycaemia
Asphyxia
Hypothermia
Polycythaemia
Abnormal neurodevelopment
8
Q

What are some clinical indicators of poor growth?

A

Syphysial-fundal height less than expected (from 24w)
Reduced liquor or amniotic fluid index
Reduced foetal movements

9
Q

List some antenatal methods for assessing fetal wellbeing with poor growth

A

Serial growth scans
Biophysical assessment
Cardiotocography (measure foetal heartbeat)
Doppler US (umbilical artery, MCA, ductus venosous)

10
Q

How is poor growth of the fetus monitored during pregnancy?

A

Syphysial-fundal height from 24 weeks
Growth scan if measurement below 10th centile
Estimated fetal weight (abdo, head circ, femur length)
Liquor volume or amniotic fluid index

11
Q

What are the main aetiology behind large babies?

A
Wrong date
Multiple pregnancy
Diabetes
Polyhydramnios
Fetal macrosomia
12
Q

What is the difference between zygosity and chorionicity?

A

Zygosity: number of eggs fertilied to produce twins
Chorionicity: membrane pattern of the twins

13
Q

Which is the outer layer - chorion or amnion?

A

Chorion outside

Amnion inside

14
Q

Describe a dichorionic diamniotic pregnancy

A

Each foetus has its own amniotic sac and its own placenta

All dizygotic twins

15
Q

Describe a monochorionic diamniotic pregnancy

A

Each foetus has its own amniotic sac but shared placenta

16
Q

Describe a monochorionic monoamniotic pregnancy

A

Both foetuses share amniotic sac and placenta

17
Q

Multiple pregnancies carry higher perinatal mortality due to what?

A
Congenital anomalies
Preterm labour
Growth restriction
Pre-eclampsia
Twin-twin transfusion
Cerebral palsy
PPH
18
Q

Outline management options for multiple pregnancy

A

Consultant-led care
Pregnancy clinic and US (MZ every 2w, DZ every 4w)
Maternal education and support

19
Q

How are triplets and twins delivered?

A

C-section if triplets

Aim for vaginal if twins

20
Q

How is multiple pregnancy diagnosed?

A

USS confirmation at 12 weeks

High AFP

21
Q

What are the clinical signs and symptoms of multiple pregnancy?

A

Exaggerated pregnancy e.g. hyperemesis gravidarum
Greater maternal age
Use of ACT
Family history

22
Q

How is fetal macrosomia diagnosed?

A

‘Big baby’

USS EFW > 90th centile

23
Q

What are the risks associated with macrosomia?

A

Clinician and maternal anxiety
Labour dystocia
Shoulder dystocia
Post partum haemorrhage

24
Q

How is fetal macrosomia managed?

A

Exclude diabetes (OGTT)
Reassurance
Conservative vs induction of labour vs c-section

25
Q

What is polyhydramnios?

A

Excess amniotic fluid

26
Q

What causes polyhydramnios?

A
Maternal diabetes 
Monochorionic twin pregnancy
Foetal anomaly
Diabetes
Hydrops fetalis (accumulating fluid in fetus)
Idiopathic
27
Q

List clinical features of polyhydramnios

A

Abdominal discomfort
Tense shiny abdomen
Malpresentation
Inability to feel fetal parts

28
Q

List diagnostic techniques for polyhydramnios

A

USS
OGTT
Serology (toxoplasmosis, CMV, parovirus)
Antibody screen

29
Q

Outline management options for polyhydramnios

A

Patient information on complications
Serial USS
Induction of labour by 40 weeks
Neonatal exam

30
Q

List complications of polyhydramnios

A

Cord prolapse
Preterm labour
Post-partum haemorrhage

31
Q

List the forms of diabetes in pregnancy

A

Pregestational (type 1, type 2, MODY)

Gestational DM

32
Q

List management options for pregestational diabetes during pregnancy

A

Pre-pregnancy counselling (HBA1c monitoring, advice)
Diabetic antenatal clinic
Consider continuous glucose monitoring
Folic acid 5mg
Low dose aspirin
Regular screening for microvascular complications
Growth scans

33
Q

Describe the pathophysiology of gestational diabetes mellitus

A

Placental hormones cause insulin resistance in the mother, causing hyperglycaemia

34
Q

How does gestational diabetes lead to macrosomia?

A

Overgrowth of insulin sensitive tissues due to hyperinsulinaemia

35
Q

How is gestational diabetes diagnosed?

A

OGTT in 1st trimester and 24-28 weeks
Fasting: 5.1 mmol/l or more
2-hour: 8.5 mmol/l or more

36
Q

List risk factors for gestational diabetes

A
Previous GDM
BMI >30
FHx
Previous big baby or big baby on USS
Polyhydramnios 
Glycosuria
37
Q

Outline antenatal management options for gestational diabetes

A
Care plan
Education on diet, weight control, exercise
Targets for glycaemic control
Growth scans 
Monitor for PET
Hypoglycaemic agents (oral or insulin)
38
Q

What is the indications for hypoglycaemic agents in gestational diabetes?

A

Diet and exercise fail to maintain target

Macrosomia on US

39
Q

What are the targets for glycaemic control in gestational diabetes?

A

Measure minimum 4 x a day and before bed
Fasting: 3.5-5.9 mmol/l
1 hr <7.8 mmol/l

40
Q

Outline postnatal management options for gestational diabetes

A

Fasting blood sugar 6-8 weeks post-natal
If T2DM suspected - OGTT 6 weeks post-natal
Annual FBS and lifestyle changes

41
Q

Maternal diabetes can cause foetal hyperinsulinaemia and increased foetal growth. What are the consequences of this?

A

Macrosomia
Polyuria, polyhydramnios
Increased O2 demands
Neonatal hypoglycaemia